Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
The Impact of High Hospital Fixed-Cost Ratios on Rural Populations
Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Explores how rurality relates to hospital cost structures as categorized by Urban Influence Codes (UICs). Describes the characteristics of hospitals at different fixed-to-total-cost ratio levels, the demographics associated with hospitals at different ratio levels, and the share of nonmetropolitan hospitals that have Critical Access Hospital (CAH) or Low-Volume Hospital (LVH) designations. Discusses how findings could be used to refine hospital payment policies.
Author(s): Abigail Barker, Eliot Jost, Timothy McBride, Keith Mueller
Date: 06/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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CAHMPAS Technical Bulletin: Revised Benchmarks and Data Exclusion Rules
Describes a review of 12 Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) benchmarks to reflect current operating conditions. Details which benchmarks were revised, unchanged, discontinued, or added. Also discusses revisions to the data exclusion rules to improve data quality.
Author(s): Aditya R. Pillutla, Kristie W. Thompson, George Pink, Kristin L. Reiter
Date: 06/2025
Sponsoring organization: Flex Monitoring Team
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Describes a review of 12 Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) benchmarks to reflect current operating conditions. Details which benchmarks were revised, unchanged, discontinued, or added. Also discusses revisions to the data exclusion rules to improve data quality.
Author(s): Aditya R. Pillutla, Kristie W. Thompson, George Pink, Kristin L. Reiter
Date: 06/2025
Sponsoring organization: Flex Monitoring Team
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2025
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Preventing Medical Debt among Rural Residents: Example Programs from Hospitals in Minnesota and Montana
Highlights the ways some rural hospitals are working to reduce medical debt for their patients. Presents a number of strategies from hospitals in Minnesota and Montana that aim to reduce patient medical debts through financial assistance programs and cost-cutting measures. Features case-studies reviewing the structure of each hospital's debt reduction efforts.
Author(s): Katie Rydberg, Sushma Shankar, Mariana Tuttle, Carrie Henning-Smith
Date: 06/2025
Sponsoring organization: University of Minnesota Rural Health Research Center
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Highlights the ways some rural hospitals are working to reduce medical debt for their patients. Presents a number of strategies from hospitals in Minnesota and Montana that aim to reduce patient medical debts through financial assistance programs and cost-cutting measures. Features case-studies reviewing the structure of each hospital's debt reduction efforts.
Author(s): Katie Rydberg, Sushma Shankar, Mariana Tuttle, Carrie Henning-Smith
Date: 06/2025
Sponsoring organization: University of Minnesota Rural Health Research Center
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Inpatient Care Experiences Are Better in Critical Access Hospitals than in Other Hospitals
Examines the inpatient care experiences of patients in Critical Access Hospitals (CAHs) and inpatient prospective payment system (IPPS) hospitals. Utilizes Hospital Consumer Assessment of Hospitals, Providers, and Systems (HCAHPS) survey scores of CAHs and IPPs to evaluate patient experience according to hospital characteristics, patient characteristics, and rural versus urban location. Discusses the importance of CAHs to rural community healthcare access.
Author(s): Megan K. Beckett, Christopher W. Cohea, Paul D. Cleary, Laura A. Giordano, Marc N. Elliott
Citation: Health Affairs Scholar, 3(5)
Date: 05/2025
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Examines the inpatient care experiences of patients in Critical Access Hospitals (CAHs) and inpatient prospective payment system (IPPS) hospitals. Utilizes Hospital Consumer Assessment of Hospitals, Providers, and Systems (HCAHPS) survey scores of CAHs and IPPs to evaluate patient experience according to hospital characteristics, patient characteristics, and rural versus urban location. Discusses the importance of CAHs to rural community healthcare access.
Author(s): Megan K. Beckett, Christopher W. Cohea, Paul D. Cleary, Laura A. Giordano, Marc N. Elliott
Citation: Health Affairs Scholar, 3(5)
Date: 05/2025
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Characteristics and Trends of Critical Access Hospitals That Own or Operate Ambulance Services
Explores trends in the number of Critical Access Hospital (CAH)-based ambulance services between 2017 and 2022. Analyzes Medicare Cost Report data to compare the characteristics of of CAHs that own and operate ambulance services to CAHs that do not. Presents findings from interviews with eight CAH-based ambulance services regarding the challenges of operating these services, including workforce recruitment and retention issues, the role of partnerships and community involvement, and lessons learned.
Author(s): John Gale, Karen Pearson, Rebecca Stearns, Zachariah Croll
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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Explores trends in the number of Critical Access Hospital (CAH)-based ambulance services between 2017 and 2022. Analyzes Medicare Cost Report data to compare the characteristics of of CAHs that own and operate ambulance services to CAHs that do not. Presents findings from interviews with eight CAH-based ambulance services regarding the challenges of operating these services, including workforce recruitment and retention issues, the role of partnerships and community involvement, and lessons learned.
Author(s): John Gale, Karen Pearson, Rebecca Stearns, Zachariah Croll
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital Electronic Clinical Quality Measure (eCQM) Resource List
Resource list for electronic clinical quality measures (eCQMs), reflecting new materials and updates from the Centers for Medicare & Medicaid Services for 2025 reporting.
Date: 05/2025
Sponsoring organization: Rural Quality Improvement Technical Assistance (RQITA) Resource Center
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Resource list for electronic clinical quality measures (eCQMs), reflecting new materials and updates from the Centers for Medicare & Medicaid Services for 2025 reporting.
Date: 05/2025
Sponsoring organization: Rural Quality Improvement Technical Assistance (RQITA) Resource Center
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Medicare Rural Hospital Flexibility Program Structure for FY 2024 – FY 2028
Outlines the purpose and allowable activities within each of the five Medicare Rural Hospital Flexibility (Flex) Program program areas, as well as suggested outcome measures for each program area.
Date: 04/2025
Sponsoring organization: National Rural Health Resource Center
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Outlines the purpose and allowable activities within each of the five Medicare Rural Hospital Flexibility (Flex) Program program areas, as well as suggested outcome measures for each program area.
Date: 04/2025
Sponsoring organization: National Rural Health Resource Center
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MedPAC Report to the Congress: Medicare Payment Policy: Skilled Nursing Facility Services: Chapter 6
Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban, rural, and frontier freestanding SNFs in 2023.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Discusses payment adequacy for skilled nursing facility (SNF) services. Features statistics on SNF care provided by rural hospitals and Critical Access Hospitals (CAHs) via swing beds and Medicare margins for urban, rural, and frontier freestanding SNFs in 2023.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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March 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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