Critical Access Hospitals (CAHs) – Resources

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, neighborhood disadvantage, 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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Patient Transfers to and from Critical Access Hospitals During the COVID-19 Pandemic
Examines inbound and outbound transfer patient volumes among Critical Access Hospitals (CAHs) during the COVID-19 pandemic. Discusses the barriers and facilitators to transferring patients that CAHs experienced. Compares transfer volume and facilitators for outbound transfers by CAH system ownership status.
Author(s): Abigail Wenninger, Madeleine Pick, Megan Lahr
Date: 02/2023
Sponsoring organization: Flex Monitoring Team
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Changes in Service Offerings Post-System Affiliation in Rural Hospitals
Explores the effects of joining or leaving a regional or national healthcare system on 62 service offerings at rural prospective payment system (PPS) hospitals and Critical Access Hospitals (CAHs) between 2008 through 2020. Compares services offered at hospitals that joined a system, left a system, were always in a system during the study period, and were never is a system during the study period.
Date: 01/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Rural Hospitals Must Keep up with Innovation to Remain Viable
Describes changes to the healthcare market environment, including technology, telehealth, services offered by retailers and large corporations, and declining patient volume. Outlines priorities for Critical Access Hospitals to remain viable, including the transition to population-based payment. Details a transition framework to guide hospitals as they move to a population-based payment system and navigate a changing environment.
Date: 01/2023
Sponsoring organization: Stroudwater Associates
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Impacts of Critical Access Hospital Independence and System Ownership during the COVID-19 Pandemic
Summarizes findings from a survey of 155 Critical Access Hospital (CAH) executives regarding experiences and challenges responding to the COVID-19 pandemic. Examines the impact of healthcare system affiliation on the CAHs' response to COVID, including the advantages and disadvantages of system affiliation and independence.
Author(s): Madeleine Pick, Megan Lahr, Abigail Wenninger
Date: 01/2023
Sponsoring organization: Flex Monitoring Team
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Efforts by Critical Access Hospitals to Increase Health Equity Through Greater Engagement with Social Determinants of Health
Examines the ways Critical Access Hospitals (CAHs) engage in upstream social determinant of health (SDOH) efforts to improve community health. Analyzes CAH and non-CAH programs that utilize screening, in-house strategies, and external partnerships to address SDOH. Discusses the impacts of SDOH policy on CAHs in rural communities.
Author(s): Bethany Lemont, Neeraj Puro, Berkeley Franz, Cory E. Cronin
Citation: Journal of Rural Health, 39(4), 728-736
Date: 2023
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Best Practices in Patient Experience at CAHs: Incorporating Lessons from COVID-19
Summarizes findings from an August 2022 meeting of high-performing Critical Access Hospitals regarding best practices for maintaining and improving healthcare quality amid challenges posed by the COVID-19 pandemic and changing healthcare landscape. Provides an overview of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Presents best practices for improving performance by HCAHPS domain. Updates the 2017 publication, A Study of HCAHPS Best Practices in High Performing Critical Access Hospitals.
Additional links: Summary
Date: 11/2022
Sponsoring organization: Stratis Health
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Financial Characteristics of Critical Access Hospitals (CAHs) Participating in Accountable Care Organizations (ACO)
Examines Critical Access Hospital (CAH) participation in Medicare and non-Medicare Accountable Care Organizations (ACOs) in 2019. Compares the organizational and financial characteristics of CAHs across facilities that participate in ACOs and those that do not participate in an ACO. Includes data on profitability, liquidity, outpatient revenue, and Medicare payer mix.
Author(s): Angelina Budko, George Pink, Susie Gurzenda, Ann Howard, Kristin L. Reiter
Date: 11/2022
Sponsoring organization: Flex Monitoring Team
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Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services
Results of an audit of Medicare Part B claims to determine whether Part B payments to Critical Access Hospitals (CAHs) for professional services and payments made to healthcare practitioners for the same services complied with federal requirements. Includes recommendations from the Office of Inspector General (OIG), and the response from the Centers for Medicare & Medicaid Services (CMS).
Additional links: Report in Brief
Date: 09/2022
Sponsoring organization: Office of Inspector General (HHS)
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