Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
Population Health Outcome Measurement Strategies for State Flex Programs
Presents a framework for population health outcome measurement strategies for State Flex Programs (SFPs). Outlines a series of sequential steps, including identifying the needs to be addressed, educational programming, developing shared learning collaboratives/cohorts to support performance improvement, and implementing interventions. Offers practical examples of population health improvement performance improvement activities with short, intermediate, and long-term outcomes to document program impact over time.
Author(s): John Gale, Celia Jewell, Sara Kahn-Troster
Date: 07/2023
Sponsoring organization: Flex Monitoring Team
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Presents a framework for population health outcome measurement strategies for State Flex Programs (SFPs). Outlines a series of sequential steps, including identifying the needs to be addressed, educational programming, developing shared learning collaboratives/cohorts to support performance improvement, and implementing interventions. Offers practical examples of population health improvement performance improvement activities with short, intermediate, and long-term outcomes to document program impact over time.
Author(s): John Gale, Celia Jewell, Sara Kahn-Troster
Date: 07/2023
Sponsoring organization: Flex Monitoring Team
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Emergency Medical Services Outcome Measurement Strategies for State Flex Programs
Presents a framework regarding emergency medical services (EMS) outcome measurement for State Flex Programs (SFPs). Outlines a series of sequential steps, including identifying the needs to be addressed, educational programming, developing shared learning collaboratives/cohorts to support performance improvement, and implementing interventions. Offers practical examples of EMS performance improvement activities with short, intermediate, and long-term outcomes.
Author(s): John Gale, Karen Pearson, Celia Jewell, Sara Kahn-Troster, Kenneth Rosati
Date: 07/2023
Sponsoring organization: Flex Monitoring Team
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Presents a framework regarding emergency medical services (EMS) outcome measurement for State Flex Programs (SFPs). Outlines a series of sequential steps, including identifying the needs to be addressed, educational programming, developing shared learning collaboratives/cohorts to support performance improvement, and implementing interventions. Offers practical examples of EMS performance improvement activities with short, intermediate, and long-term outcomes.
Author(s): John Gale, Karen Pearson, Celia Jewell, Sara Kahn-Troster, Kenneth Rosati
Date: 07/2023
Sponsoring organization: Flex Monitoring Team
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Delta Region Community Health Systems Development (DRCHSD) Program: Revenue Cycle Management Best Practices Guide
Offers rural hospital executives and management teams best practice concepts in revenue cycle management by assisting them in identifying performance improvement within their hospitals and departments. Provides State Offices of Rural Health (SORH) directors and Flex Program coordinators a better understanding of the revenue cycle best practices to help them design educational training programs to support rural hospital administrators with performance improvement.
Additional links: Check List
Date: 07/2023
Sponsoring organizations: BKD CPAs & Advisors, National Rural Health Resource Center
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Offers rural hospital executives and management teams best practice concepts in revenue cycle management by assisting them in identifying performance improvement within their hospitals and departments. Provides State Offices of Rural Health (SORH) directors and Flex Program coordinators a better understanding of the revenue cycle best practices to help them design educational training programs to support rural hospital administrators with performance improvement.
Additional links: Check List
Date: 07/2023
Sponsoring organizations: BKD CPAs & Advisors, National Rural Health Resource Center
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The Impact of COVID-19 on CAH Financial Indicators
Describes the impact of the COVID-19 pandemic on Critical Access Hospital (CAH) financial indicators. Compares summary statistics on CAH financial indicators across eight categories in the six years prior to the pandemic (April 2015 - March 2020) to the same metrics during the pandemic (April 2020 - March 2022).
Author(s): Laura McFadyen, George Pink, Susie Gurzenda, Kristie W. Thompson, Kristin L. Reiter
Date: 06/2023
Sponsoring organization: Flex Monitoring Team
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Describes the impact of the COVID-19 pandemic on Critical Access Hospital (CAH) financial indicators. Compares summary statistics on CAH financial indicators across eight categories in the six years prior to the pandemic (April 2015 - March 2020) to the same metrics during the pandemic (April 2020 - March 2022).
Author(s): Laura McFadyen, George Pink, Susie Gurzenda, Kristie W. Thompson, Kristin L. Reiter
Date: 06/2023
Sponsoring organization: Flex Monitoring Team
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The Impact of COVID-19 Funding on Profitability of Critical Access Hospitals
Examines the impacts of COVID-19 Public Health Emergency (PHE) funding on Critical Access Hospitals (CAHs). Compares CAH operating margins in the six years prior to the pandemic (April 2015 - March 2020) to operating margins during the pandemic (April 2020 - March 2022). Offers estimates to what CAH profitability would have been if CAHs did not receive PHE funding.
Author(s): Laura McFadyen, George Pink, Susie Gurzenda, Kristie W. Thompson, Kristin L. Reiter
Date: 06/2023
Sponsoring organization: Flex Monitoring Team
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Examines the impacts of COVID-19 Public Health Emergency (PHE) funding on Critical Access Hospitals (CAHs). Compares CAH operating margins in the six years prior to the pandemic (April 2015 - March 2020) to operating margins during the pandemic (April 2020 - March 2022). Offers estimates to what CAH profitability would have been if CAHs did not receive PHE funding.
Author(s): Laura McFadyen, George Pink, Susie Gurzenda, Kristie W. Thompson, Kristin L. Reiter
Date: 06/2023
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospitals: Views on How Medicare Payment and Other Factors Affect Behavioral Health Services
Provides an overview of how Medicare payment policies for care provided by Critical Access Hospitals (CAHs). Explores how CAHs provide behavioral health services in their communities. Summarizes findings from interviews with officials from 10 CAHs, stakeholder organizations, the Centers for Medicare & Medicaid Services (CMS), and the Health Resources and Services Administration (HRSA) regarding how Medicare payment policies and other factors affect CAHs' ability to provide behavioral health services.
Additional links: Full Report
Date: 06/2023
Sponsoring organization: Government Accountability Office
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Provides an overview of how Medicare payment policies for care provided by Critical Access Hospitals (CAHs). Explores how CAHs provide behavioral health services in their communities. Summarizes findings from interviews with officials from 10 CAHs, stakeholder organizations, the Centers for Medicare & Medicaid Services (CMS), and the Health Resources and Services Administration (HRSA) regarding how Medicare payment policies and other factors affect CAHs' ability to provide behavioral health services.
Additional links: Full Report
Date: 06/2023
Sponsoring organization: Government Accountability Office
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How Regional Partnerships Bolster Rural Hospitals
Explores how Critical Access Hospitals (CAHs) and other rural providers partner to overcome challenges. Profiles six regional partnerships that address staffing, quality improvement, contracts with payers, value-based payment, and community development. Offers lessons learned that could inform policy changes to strengthen rural providers.
Author(s): Martha Hostetter, Sarah Klein
Date: 05/2023
Sponsoring organization: Commonwealth Fund
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Explores how Critical Access Hospitals (CAHs) and other rural providers partner to overcome challenges. Profiles six regional partnerships that address staffing, quality improvement, contracts with payers, value-based payment, and community development. Offers lessons learned that could inform policy changes to strengthen rural providers.
Author(s): Martha Hostetter, Sarah Klein
Date: 05/2023
Sponsoring organization: Commonwealth Fund
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Closed, Converted, Merged, and New Hospitals with Medicare Rural Designations: January 2018-November 2022
Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Sponsoring organization: Congressional Research Service
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Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Sponsoring organization: Congressional Research Service
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Analysis of Hospital Operating Margins and Provision of Safety Net Services
Explores the association between five hospital safety net services - undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, and Sole Community Hospital and Critical Access Hospital status - and hospital operating margins. Includes information on the relationship between bed count, Census region, urban/rural location, ownership status, and having a Graduate Medical Education residency program with operating margins.
Author(s): Lukas K. Gaffney, Kenneth A. Michelson
Citation: JAMA Network Open, 6(4), e238785
Date: 04/2023
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Explores the association between five hospital safety net services - undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, and Sole Community Hospital and Critical Access Hospital status - and hospital operating margins. Includes information on the relationship between bed count, Census region, urban/rural location, ownership status, and having a Graduate Medical Education residency program with operating margins.
Author(s): Lukas K. Gaffney, Kenneth A. Michelson
Citation: JAMA Network Open, 6(4), e238785
Date: 04/2023
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Building Sustainable Capacity for Quality and Organizational Excellence: Critical Access Hospital Quality Infrastructure Summit
Summarizes a March 2023 summit with experts that sought to identify the core elements of infrastructure necessary for successful quality efforts in Critical Access Hospitals (CAHs). Outlines a framework to help leaders assess needs and growth and consider holistic approaches to creating a sustainable quality infrastructure.
Additional links: Core Elements of Critical Access Hospital Quality Infrastructure Video Summary, National Critical Access Hospital Quality Inventory and Assessment: Critical Access Hospital Fact Sheet, National Critical Access Hospital Quality Inventory and Assessment: State Flex Program Fact Sheet, National Critical Access Hospital Quality Inventory and Assessment: Video Summary
Date: 03/2023
Sponsoring organizations: Flex Monitoring Team, National Rural Health Resource Center, Stratis Health
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Summarizes a March 2023 summit with experts that sought to identify the core elements of infrastructure necessary for successful quality efforts in Critical Access Hospitals (CAHs). Outlines a framework to help leaders assess needs and growth and consider holistic approaches to creating a sustainable quality infrastructure.
Additional links: Core Elements of Critical Access Hospital Quality Infrastructure Video Summary, National Critical Access Hospital Quality Inventory and Assessment: Critical Access Hospital Fact Sheet, National Critical Access Hospital Quality Inventory and Assessment: State Flex Program Fact Sheet, National Critical Access Hospital Quality Inventory and Assessment: Video Summary
Date: 03/2023
Sponsoring organizations: Flex Monitoring Team, National Rural Health Resource Center, Stratis Health
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Last Updated: 4/23/2025