Critical Access Hospitals (CAHs) – Resources
Selected recent or important resources focusing on Critical Access Hospitals (CAHs).
2023 National CAH Quality Inventory & Assessment National Report
Presents a high-level summary of key data points from the October-December 2023 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Author(s): Megan Lahr, Robert Barclay, Madeleine Pick
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Presents a high-level summary of key data points from the October-December 2023 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Author(s): Megan Lahr, Robert Barclay, Madeleine Pick
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Health Care Coalitions: A Resource to Support Critical Access Hospital Emergency Preparedness Planning
Describes unique challenges Critical Access Hospitals (CAHs) face regarding emergency preparedness planning. Presents findings from interviews with leaders from 8 statewide or regional healthcare coalitions (HCCs) regarding strategies and resources HCCs provide to support the CAH emergency preparedness planning process. Outlines the functions and roles of HCCs by the 4 Administration for Strategic Preparedness and Response (ASPR) capability goals.
Author(s): John Gale, Karen Pearson, Rebecca Stearns
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Describes unique challenges Critical Access Hospitals (CAHs) face regarding emergency preparedness planning. Presents findings from interviews with leaders from 8 statewide or regional healthcare coalitions (HCCs) regarding strategies and resources HCCs provide to support the CAH emergency preparedness planning process. Outlines the functions and roles of HCCs by the 4 Administration for Strategic Preparedness and Response (ASPR) capability goals.
Author(s): John Gale, Karen Pearson, Rebecca Stearns
Date: 04/2024
Sponsoring organization: Flex Monitoring Team
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Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2022
Examines the economic and healthcare benefit of Critical Access Hospitals (CAHs) on rural communities. Looks at the services provided, the economic health of CAHs, and the effect this has on their communities broadly. Includes comparisons of community benefit and patient care services indicators provided by CAHs and other rural and urban hospitals.
Author(s): Zachariah Croll, John Gale
Date: 03/2024
Sponsoring organization: Flex Monitoring Team
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Examines the economic and healthcare benefit of Critical Access Hospitals (CAHs) on rural communities. Looks at the services provided, the economic health of CAHs, and the effect this has on their communities broadly. Includes comparisons of community benefit and patient care services indicators provided by CAHs and other rural and urban hospitals.
Author(s): Zachariah Croll, John Gale
Date: 03/2024
Sponsoring organization: Flex Monitoring Team
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Partnerships to Address Social Needs Across Metropolitan and Non-Metropolitan Prospective Payment System Hospitals and Critical Access Hospitals
Explores the extent to which hospitals partner with community organizations to address population and/or community health needs. Analyzes data from the 2021 American Hospital Association Social Determinants of Health (SDOH) Supplement to describe the number and types of hospital partnerships with community-based organizations. Compares results by hospital type - metropolitan prospective payment system (PPS), Critical Access Hospital (CAH), and non-metropolitan PPS - and by U.S. Census region, ownership status, and accountable care organization (ACO) participation.
Author(s): Whitney E. Zahnd, Khyathi Gadag, Kristin D. Wilson, Keith J. Mueller
Date: 03/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Explores the extent to which hospitals partner with community organizations to address population and/or community health needs. Analyzes data from the 2021 American Hospital Association Social Determinants of Health (SDOH) Supplement to describe the number and types of hospital partnerships with community-based organizations. Compares results by hospital type - metropolitan prospective payment system (PPS), Critical Access Hospital (CAH), and non-metropolitan PPS - and by U.S. Census region, ownership status, and accountable care organization (ACO) participation.
Author(s): Whitney E. Zahnd, Khyathi Gadag, Kristin D. Wilson, Keith J. Mueller
Date: 03/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Report to Congress on Medicaid and CHIP, March 2024
Reports on three aspects of Medicaid of interest to Congress: 1) improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs) and federal government actions to aid states, 2) increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and 3) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 3 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the number of hospitals with high levels of uncompensated care that also provide essential community services. Table 3-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2024
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on three aspects of Medicaid of interest to Congress: 1) improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs) and federal government actions to aid states, 2) increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and 3) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 3 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the number of hospitals with high levels of uncompensated care that also provide essential community services. Table 3-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2024
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Unrelenting Pressure Pushes Rural Safety Net Crisis Into Uncharted Territory
Examines financial and operational metrics for rural hospitals. Discusses the growth of Medicare Advantage (MA) enrollment in rural communities between 2019 and 2023, the impact of MA on rural hospital reimbursement, how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities, and the discontinuation of obstetrics and chemotherapy services at rural hospitals since 2011. Includes the percentage of rural hospitals in each state vulnerable to closure and nine factors significantly associated with rural hospital vulnerability.
Date: 02/2024
Sponsoring organization: Chartis Center for Rural Health
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Examines financial and operational metrics for rural hospitals. Discusses the growth of Medicare Advantage (MA) enrollment in rural communities between 2019 and 2023, the impact of MA on rural hospital reimbursement, how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities, and the discontinuation of obstetrics and chemotherapy services at rural hospitals since 2011. Includes the percentage of rural hospitals in each state vulnerable to closure and nine factors significantly associated with rural hospital vulnerability.
Date: 02/2024
Sponsoring organization: Chartis Center for Rural Health
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EHR Capabilities and Interoperability in Critical Access Hospitals
Explores the electronic health record (EHR) and interoperable health information exchange capabilities among Critical Access Hospitals (CAHs) in 2019. Analyzes 2019 American Hospital Association Information Technology Supplement (AHAIT) survey data, which includes data from nearly 700 CAHs. Compares EHR capabilities and the use of electronic methods for four interoperability domains by CAH status and system affiliation. Discusses how to support CAHs in advancing information sharing and using comprehensive EHRs.
Author(s): Madeleine Pick, Alyssa Furukawa, Megan Lahr, Dori Cross
Date: 01/2024
Sponsoring organization: Flex Monitoring Team
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Explores the electronic health record (EHR) and interoperable health information exchange capabilities among Critical Access Hospitals (CAHs) in 2019. Analyzes 2019 American Hospital Association Information Technology Supplement (AHAIT) survey data, which includes data from nearly 700 CAHs. Compares EHR capabilities and the use of electronic methods for four interoperability domains by CAH status and system affiliation. Discusses how to support CAHs in advancing information sharing and using comprehensive EHRs.
Author(s): Madeleine Pick, Alyssa Furukawa, Megan Lahr, Dori Cross
Date: 01/2024
Sponsoring organization: Flex Monitoring Team
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Critical Access Hospital-Local Health Department Partnerships to Address Rural Community Needs
Explores Critical Access Hospital (CAH) involvement in collaborative community health networks that include local public health departments (LHDs), other healthcare organizations, social service agencies, and other community organizations. Uses survey data from the American Hospital Association (AHA) to describe the collaborative partnerships CAHs are engaged in, the organizations with which they partner, and the activities these partnerships undertake. Presents findings from qualitative interviews with four pairs of CAH and LHD leaders regarding challenges and lessons learned from these local-level collaborations. Identifies three areas of activity - community health needs assessments, emergency preparedness planning, and emergent public health crises - that provide an opportunity to encourage collaboration between CAHs and LHDs and address priority needs.
Author(s): Zachariah Croll, Celia Jewell, John Gale
Date: 01/2024
Sponsoring organization: Flex Monitoring Team
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Explores Critical Access Hospital (CAH) involvement in collaborative community health networks that include local public health departments (LHDs), other healthcare organizations, social service agencies, and other community organizations. Uses survey data from the American Hospital Association (AHA) to describe the collaborative partnerships CAHs are engaged in, the organizations with which they partner, and the activities these partnerships undertake. Presents findings from qualitative interviews with four pairs of CAH and LHD leaders regarding challenges and lessons learned from these local-level collaborations. Identifies three areas of activity - community health needs assessments, emergency preparedness planning, and emergent public health crises - that provide an opportunity to encourage collaboration between CAHs and LHDs and address priority needs.
Author(s): Zachariah Croll, Celia Jewell, John Gale
Date: 01/2024
Sponsoring organization: Flex Monitoring Team
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A Comparison of Non-Operating Revenue between Rural and Urban Hospitals
Compares the relative percentage and composition of non-operating revenue (NOR) among Critical Access Hospitals (CAHs), rural Prospective Payment System (R-PPS) hospitals, and urban Prospective Payment System (U-PPS) hospitals from 2011-2019. Describes how hospitals can use NOR to offset negative operating incomes. Presents data on the composition of NOR by hospital type and ownership.
Author(s): Ariana Pitcher, Ruoyu Zhang, Susie Gurzenda, George Pink, Kristin L. Reiter
Date: 11/2023
Sponsoring organization: Flex Monitoring Team
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Compares the relative percentage and composition of non-operating revenue (NOR) among Critical Access Hospitals (CAHs), rural Prospective Payment System (R-PPS) hospitals, and urban Prospective Payment System (U-PPS) hospitals from 2011-2019. Describes how hospitals can use NOR to offset negative operating incomes. Presents data on the composition of NOR by hospital type and ownership.
Author(s): Ariana Pitcher, Ruoyu Zhang, Susie Gurzenda, George Pink, Kristin L. Reiter
Date: 11/2023
Sponsoring organization: Flex Monitoring Team
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Performance Management/Program Evaluation Guide: Medicare Rural Hospital Flexibility (Flex) Program
Offers guidance to state Flex program coordinators to incorporate performance management and evaluation into Flex program operations as required by the Flex Program Cooperative Agreement. Supports the state's capacity for assessing program activities, making improvements, and establishing if activities are effective. Defines key terms and concepts, discusses reporting requirements, demonstrates a performance year work plan, covers data collection, and provides examples of goals and measures to be included in the evaluation plan.
Additional links: Flex Program Glossary of Evaluation Terms, Quick List: Flex Program Evaluation Resources
Date: 10/2023
Sponsoring organization: National Rural Health Resource Center
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Offers guidance to state Flex program coordinators to incorporate performance management and evaluation into Flex program operations as required by the Flex Program Cooperative Agreement. Supports the state's capacity for assessing program activities, making improvements, and establishing if activities are effective. Defines key terms and concepts, discusses reporting requirements, demonstrates a performance year work plan, covers data collection, and provides examples of goals and measures to be included in the evaluation plan.
Additional links: Flex Program Glossary of Evaluation Terms, Quick List: Flex Program Evaluation Resources
Date: 10/2023
Sponsoring organization: National Rural Health Resource Center
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Last Updated: 3/12/2026