Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
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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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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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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Critical Access Hospital Workforce During COVID-19: Barriers and Facilitators for Recruiting and Retaining Staff
Presents findings from a survey of Critical Access Hospital (CAH) executives regarding the specific types of staff positions they have had challenges recruiting and retaining. Compares results by system affiliation. Discusses the barriers and facilitators to recruiting and retaining hospital staff.
Author(s): Madeleine Pick, Megan Lahr
Date: 02/2023
Sponsoring organization: Flex Monitoring Team
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Presents findings from a survey of Critical Access Hospital (CAH) executives regarding the specific types of staff positions they have had challenges recruiting and retaining. Compares results by system affiliation. Discusses the barriers and facilitators to recruiting and retaining hospital staff.
Author(s): Madeleine Pick, Megan Lahr
Date: 02/2023
Sponsoring organization: Flex Monitoring Team
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Care Coordination and Community Partnerships for Cancer Care in Critical Access Hospitals
Presents findings from a survey of 135 Critical Access Hospitals (CAHs) regarding care coordination practices for patients with cancer. Describes the types of care coordination services provided by CAHs and the staff that provide these services. Discusses partnerships between CAHs and community organizations regarding cancer initiatives.
Author(s): Megan Lahr, Xiomara Santana, Nathan Bean, Helen Parsons, Ira Moscovice
Date: 01/2023
Sponsoring organization: Flex Monitoring Team
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Presents findings from a survey of 135 Critical Access Hospitals (CAHs) regarding care coordination practices for patients with cancer. Describes the types of care coordination services provided by CAHs and the staff that provide these services. Discusses partnerships between CAHs and community organizations regarding cancer initiatives.
Author(s): Megan Lahr, Xiomara Santana, Nathan Bean, Helen Parsons, Ira Moscovice
Date: 01/2023
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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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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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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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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Characteristics of Rural Hospitals Eligible for Conversion to Rural Emergency Hospitals and Three Rural Hospitals Considering Conversion
Findings brief presenting updated data for Rural Emergency Hospital (REH)-eligible hospitals. Compares financial and operational measures of 3 rural hospitals that have expressed interest in REH conversion with those of all 1,787 REH-eligible hospitals. Also discusses what factors may determine the number of rural hospitals that convert to REH, including risk of permanent closure.
Author(s): George Pink, Susie Gurzenda, Kristie Thompson, Ann Howard
Date: 12/2022
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief presenting updated data for Rural Emergency Hospital (REH)-eligible hospitals. Compares financial and operational measures of 3 rural hospitals that have expressed interest in REH conversion with those of all 1,787 REH-eligible hospitals. Also discusses what factors may determine the number of rural hospitals that convert to REH, including risk of permanent closure.
Author(s): George Pink, Susie Gurzenda, Kristie Thompson, Ann Howard
Date: 12/2022
Sponsoring organization: North Carolina Rural Health Research Program
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Rates of Limited English Proficiency in Counties with Critical Access Hospitals
Describes the rates of residents with limited English proficiency (LEP) in counties with at least one Critical Access Hospital. Summarizes research on the relationship between the availability of language interpreting services and better healthcare outcomes.
Author(s): Robert Barclay, Nathan Bean, Madeleine Pick, Megan Lahr
Date: 12/2022
Sponsoring organization: Flex Monitoring Team
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Describes the rates of residents with limited English proficiency (LEP) in counties with at least one Critical Access Hospital. Summarizes research on the relationship between the availability of language interpreting services and better healthcare outcomes.
Author(s): Robert Barclay, Nathan Bean, Madeleine Pick, Megan Lahr
Date: 12/2022
Sponsoring organization: Flex Monitoring Team
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Last Updated: 4/23/2025