Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
Rural Health Research Recap: Rural Hospital Closures: 2023 Update
Summarizes recent research from Rural Health Research Centers examining hospital closures. Features statistics including number of acute hospitals as of 2020 with breakdowns by type and location, rural hospital closures from 2005-2022 with breakdowns by isolated rural, small rural, and large rural location, and numbers of closures by year from 2005-2022 with breakdowns by complete or converted closures.
Author(s): Per Ostmo
Date: 06/2023
Type: Document
Sponsoring organization: Rural Health Research Gateway
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Summarizes recent research from Rural Health Research Centers examining hospital closures. Features statistics including number of acute hospitals as of 2020 with breakdowns by type and location, rural hospital closures from 2005-2022 with breakdowns by isolated rural, small rural, and large rural location, and numbers of closures by year from 2005-2022 with breakdowns by complete or converted closures.
Author(s): Per Ostmo
Date: 06/2023
Type: Document
Sponsoring organization: Rural Health Research Gateway
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Interoperability among Hospitals Treating Populations That Have Been Marginalized
Examines how hospitals that serve more marginalized patients engage with interoperability. Compares the percentage of hospitals supporting interoperable exchange and participating in national networks by hospital characteristics, including Critical Access Hospital (CAH) designation and rural-urban status.
Author(s): Jordan Everson, Vaishali Patel, Andrew W. Bazemore, Robert L. Phillips
Citation: Health Services Research, 58(4), 853-864
Date: 05/2023
Type: Document
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Examines how hospitals that serve more marginalized patients engage with interoperability. Compares the percentage of hospitals supporting interoperable exchange and participating in national networks by hospital characteristics, including Critical Access Hospital (CAH) designation and rural-urban status.
Author(s): Jordan Everson, Vaishali Patel, Andrew W. Bazemore, Robert L. Phillips
Citation: Health Services Research, 58(4), 853-864
Date: 05/2023
Type: Document
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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
Type: Document
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
Type: Document
Sponsoring organization: Commonwealth Fund
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Factors Associated with Lengths-of-Stay for Inpatients with Substance Use Disorders
Policy brief identifying factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs) and exploring whether there are systematic differences in LOS for rural and urban residents. Includes statistics on characteristics of stays for a primary SUD diagnosis in Kentucky, North Carolina, Vermont, and Washington in 2018, with breakdowns by Mental Health Professional Shortage Area and rural or urban location, and selected factors on LOS for an SUD diagnosis, with breakdowns by mental diagnoses, chronic conditions, and socio-demographic measures.
Author(s): Curt Mueller, Craig Holden, Shena Popat, Alana Knudson
Date: 04/2023
Type: Document
Sponsoring organization: Rural Health Equity Research Center
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Policy brief identifying factors associated with inpatient length-of-stay (LOS) for the treatment of substance use disorders (SUDs) and exploring whether there are systematic differences in LOS for rural and urban residents. Includes statistics on characteristics of stays for a primary SUD diagnosis in Kentucky, North Carolina, Vermont, and Washington in 2018, with breakdowns by Mental Health Professional Shortage Area and rural or urban location, and selected factors on LOS for an SUD diagnosis, with breakdowns by mental diagnoses, chronic conditions, and socio-demographic measures.
Author(s): Curt Mueller, Craig Holden, Shena Popat, Alana Knudson
Date: 04/2023
Type: Document
Sponsoring organization: Rural Health Equity Research Center
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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
Type: Document
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
Type: Document
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, 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
Type: Document
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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, 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
Type: Document
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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
Type: Document
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
Type: Document
Sponsoring organizations: Flex Monitoring Team, National Rural Health Resource Center, Stratis Health
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Modernizing Payment to Critical Access Hospitals: A Proposal for the Next Iteration of the Flex Program
Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
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Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
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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
Type: Document
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
Type: Document
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
Type: Document
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
Type: Document
Sponsoring organization: Flex Monitoring Team
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Last Updated: 5/29/2024