Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
Hospital Differences in Adult Inpatient Stays with Healthcare-Associated Infections, 2019 and 2021
Examines the rate of adult inpatient hospital stays involving five healthcare-associated infections (HAI) in 2019 and 2021. Presents data from an analysis of 2019 and 2021 State Inpatient Databases (SID) from public, non-federal acute-care hospitals across 38 states by hospital characteristics, including ownership, rural or urban location, safety-net designation, and Critical Access Hospital designation.
Author(s): Melissa A. Miller, Leyi Lin, David P. Calfee, Amy Gehrke, Alex Bohl
Date: 10/2024
Sponsoring organization: Agency for Healthcare Research and Quality
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Examines the rate of adult inpatient hospital stays involving five healthcare-associated infections (HAI) in 2019 and 2021. Presents data from an analysis of 2019 and 2021 State Inpatient Databases (SID) from public, non-federal acute-care hospitals across 38 states by hospital characteristics, including ownership, rural or urban location, safety-net designation, and Critical Access Hospital designation.
Author(s): Melissa A. Miller, Leyi Lin, David P. Calfee, Amy Gehrke, Alex Bohl
Date: 10/2024
Sponsoring organization: Agency for Healthcare Research and Quality
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Medicare Payment Basics: Critical Access Hospitals Payment System
Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Presents an overview of Medicare payments for Critical Access Hospitals (CAHs). Compares differences in Medicare payments for CAHs, Sole Community Hospitals, and Medicare-Dependent Hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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September 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare's overall financial situation, cost-sharing for outpatient services at Critical Access Hospitals, and experiences and challenges of measuring the quality of care provided by rural providers.
Additional links: Cost Sharing for Outpatient Services at Critical Access Hospitals - Presentation Slides, Medicare's Measurement of Rural Provider Quality - Presentation Slides
Date: 09/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare's overall financial situation, cost-sharing for outpatient services at Critical Access Hospitals, and experiences and challenges of measuring the quality of care provided by rural providers.
Additional links: Cost Sharing for Outpatient Services at Critical Access Hospitals - Presentation Slides, Medicare's Measurement of Rural Provider Quality - Presentation Slides
Date: 09/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Workforce Toolkit to Support Critical Access Hospitals and Rural Providers
Toolkit intended to help Critical Access Hospitals (CAHs) and other rural providers improve workforce recruitment and retention efforts. Provides information on healthcare workforce challenges faced by CAHs. Offers examples of external resources that CAHs may utilize to address their workforce needs across four topics: organizational culture and leadership, leveraging partnerships, emergency medical services workforce, and administrative and support staff workforce.
Date: 09/2024
Sponsoring organization: Flex Monitoring Team
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Toolkit intended to help Critical Access Hospitals (CAHs) and other rural providers improve workforce recruitment and retention efforts. Provides information on healthcare workforce challenges faced by CAHs. Offers examples of external resources that CAHs may utilize to address their workforce needs across four topics: organizational culture and leadership, leveraging partnerships, emergency medical services workforce, and administrative and support staff workforce.
Date: 09/2024
Sponsoring organization: Flex Monitoring Team
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Small Rural Hospital and Clinic Finance 101
Provides a manual with introductory information on healthcare facility finances and payment for state Medicare Rural Hospital Flexibility (Flex) Program personnel, Critical Access Hospital (CAH) staff and board members, small rural prospective payment system (PPS) hospitals, and provider-based rural health clinics (RHC).
Date: 09/2024
Sponsoring organization: National Rural Health Resource Center
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Provides a manual with introductory information on healthcare facility finances and payment for state Medicare Rural Hospital Flexibility (Flex) Program personnel, Critical Access Hospital (CAH) staff and board members, small rural prospective payment system (PPS) hospitals, and provider-based rural health clinics (RHC).
Date: 09/2024
Sponsoring organization: National Rural Health Resource Center
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FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Health Care: Supporting Lives and Improving Communities
Presents the U.S. Senate Committee on Finance May 16, 2024, hearing on rural healthcare. Discusses the financial vulnerability of rural hospitals, the rural healthcare workforce and graduate medical education (GME), access to maternal healthcare, health information technology and telehealth, and more. Features testimony from the Chartis Center for Rural Health; Grande Ronde Hospital, a Critical Access Hospital in Oregon; the Wisconsin Collaborative for Rural Graduate Medical Education; and the Rural Policy Research Institute.
Additional links: Jeremy P. Davis, Grande Ronde Hospital - Testimony, Keith J. Mueller, Rural Policy Research Institute - Testimony, Lori Rodefeld, Wisconsin Collaborative for Rural Graduate Medical Education - Testimony, Michael Topchik, Chartis Center for Rural Health - Testimony
Date: 05/2024
Sponsoring organization: Senate Committee on Finance
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Presents the U.S. Senate Committee on Finance May 16, 2024, hearing on rural healthcare. Discusses the financial vulnerability of rural hospitals, the rural healthcare workforce and graduate medical education (GME), access to maternal healthcare, health information technology and telehealth, and more. Features testimony from the Chartis Center for Rural Health; Grande Ronde Hospital, a Critical Access Hospital in Oregon; the Wisconsin Collaborative for Rural Graduate Medical Education; and the Rural Policy Research Institute.
Additional links: Jeremy P. Davis, Grande Ronde Hospital - Testimony, Keith J. Mueller, Rural Policy Research Institute - Testimony, Lori Rodefeld, Wisconsin Collaborative for Rural Graduate Medical Education - Testimony, Michael Topchik, Chartis Center for Rural Health - Testimony
Date: 05/2024
Sponsoring organization: Senate Committee on Finance
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Differences in Measurement of Operating Margin: An Update
Describes how differences in measurement of operating margin for hospitals can affect the reported values. Compares the operating margins of urban and rural prospective payment system hospitals and Critical Access Hospitals (CAHs) across three definitions of operating margin using Medicare Cost Report data from April 2021 through March 2022. Describes situations in which each operating margin would be the most appropriate to calculate. Updates a 2008 study from the Flex Monitoring Team.
Author(s): Jessie Ma, Susie Gurzenda, Kristin Reiter, George Pink
Date: 05/2024
Sponsoring organization: North Carolina Rural Health Research Program
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Describes how differences in measurement of operating margin for hospitals can affect the reported values. Compares the operating margins of urban and rural prospective payment system hospitals and Critical Access Hospitals (CAHs) across three definitions of operating margin using Medicare Cost Report data from April 2021 through March 2022. Describes situations in which each operating margin would be the most appropriate to calculate. Updates a 2008 study from the Flex Monitoring Team.
Author(s): Jessie Ma, Susie Gurzenda, Kristin Reiter, George Pink
Date: 05/2024
Sponsoring organization: North Carolina Rural Health Research Program
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Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress
Describes the relative risk of rural hospitals and selected urban hospitals experiencing financial distress in 2023. Provides an overview of an updated Financial Distress Index (FDI), which incorporates variables reflecting changes to operational environments since the publication of the 2017 FDI to predict and analyze financial distress and risk of rural hospital closure. Presents data on the characteristics of hospitals by relative risk of financial distress in 2023 and the number of hospitals in each state across in category of relative risk of financial distress.
Author(s): Tyler Malone, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2024
Sponsoring organization: North Carolina Rural Health Research Program
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Describes the relative risk of rural hospitals and selected urban hospitals experiencing financial distress in 2023. Provides an overview of an updated Financial Distress Index (FDI), which incorporates variables reflecting changes to operational environments since the publication of the 2017 FDI to predict and analyze financial distress and risk of rural hospital closure. Presents data on the characteristics of hospitals by relative risk of financial distress in 2023 and the number of hospitals in each state across in category of relative risk of financial distress.
Author(s): Tyler Malone, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2024
Sponsoring organization: North Carolina Rural Health Research Program
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2023 National CAH Quality Inventory & Assessment National Report
Presents a high-level summary of key data points from the October-December 2023 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Author(s): Megan Lahr, Robert Barclay, Madeleine Pick
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Presents a high-level summary of key data points from the October-December 2023 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Author(s): Megan Lahr, Robert Barclay, Madeleine Pick
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Last Updated: 5/14/2025