Tools
AHA Issues: Critical Access Hospitals
Web site
Information on American Hospital Association (AHA) advocacy activities related to Critical Access Hospitals (CAHs). Includes news, resources, and more.
AHRQ Quality Indicators Toolkit for Hospitals
Web site
Helps hospitals understand the Quality Indicators (QIs) from the Agency for Healthcare Research and Quality (AHRQ), and support the use of them to successfully improve quality and patient safety in hospitals.
CAH Information
Web site
Lists Critical Access Hospitals (CAHs) for the entire country and by state, as well as a map of CAH locations and quarterly data by state on conversion to the CAH program.
CAH Legislative History
Web site
Describes pieces of legislation that have resulted in the creation and modification of the critical access hospital (CAH) program.
CAH State Level Data Indicators
Web site
State-level reports on the financial, quality, and community benefit indicators of Critical Access Hospitals (CAHs).
Certification & Compliance: Critical Access Hospitals
Web site
Provides basic information about being certified as a Medicare Critical Access Hospital (CAH) provider and includes links to applicable laws, regulations, and compliance information.
CMS Critical Access Hospitals Center
Web site
Presents regulations and notices, press releases, program memorandums, and other information from CMS related to the Critical Access Hospitals (CAH) program.
CMS Recovery Audit Contractor (RAC)
Web site
Provides information on the Recovery Audit Contractor (RAC) project, implementation strategies, who the RACs are, RAC jurisdictions, RAC expansion and provider outreach schedules, and FAQs.
CMS State Survey Agency Directory
Web site
Contains a directory of state agencies that handle survey and certification of certain health care facilities for compliance with the Medicare health and safety standards. Updated quarterly.
Executive Primer on Hospital Environmental Sustainability
Web site
Provides hospital managers, staff, and designers of health care facilities, information about sustainability issues relevant to hospitals.
Health Information Technology State Profiles
Web site
Collections of health information technology (HIT) resources for each state.
Health Information Technology Toolkit for Critical Access and Small Hospitals
Web site
Provides critical access and small hospitals numerous resources in health information technology (HIT), including tools for telehealth, health information exchange, and personal health records.
Health IT - Meaningful Use Resources
Web site
Resource devoted to helping hospital leaders better understand the Medicare and Medicaid electronic health records incentive programs and their associated "meaningful use" requirements.
HealthCare.gov Implementation Center
Web site
Materials related to the implementation of the Affordable Care Act, including regulations, authorities and requests for comment.
Hospital Classification (SCH/CAH/Rural)
Database
Offers lists of sole community hospitals (SCH), critical access hospitals (CAHs), CAH inpatient and outpatient cost to charge ratios (CCRs), plus rural hospitals under 100 beds and rural sole community hospitals under 100 beds.
HRSA: Rural Health
Web site
Provides rural health resources that include grant information, technical assistance, and research publications.
ICD-10 For Safety Net Providers
Web site
Provides resources on ICD-10 and Version 5010 to support the transition from ICD-9 to ICD-10.
Joint Commission: Critical Access Hospital Accreditation
Web site
Information on the Joint Commission survey process for certification of Critical Access Hospitals (CAHs).
Medicare Modernization Act
Web site
Includes information on CMS implementation of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). Includes links to CMS fact sheets and press releases, as well as other resources for understanding the impact of the MMA.
Performance Improvement Services
Web site
Lists distance and web-based educational resources for rural hospitals.
QualityNet
Web site
CMS-approved website for secure communications and healthcare quality data exchange between: quality improvement organizations (QIOs), hospitals, physician offices, nursing homes, end stage renal disease (ESRD) networks and facilities, and data vendors.
Rural Health Open Door Forum
Web site
Provides information on CMS teleconference forums addressing rural health issues. Covers Rural Health Clinic (RHC), Community Access Hospital (CAH) and Federally Qualified Health Center (FQHC) issues. Includes call-in instructions for the next forum and how to register for the mailing list.
Rural Health Research: Critical Access Hospitals and Rural Hospital Flexibility Program
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Critical Access Hospitals and the Rural Hospital Flexibility Program, produced by the Office of Rural Health Policy's funded rural health research centers.
Sustainability Roadmap for Hospitals: A Guide to Achieving Your Sustainability Goals
Web site
Provides health care executives with information and tools that can help reduce the environmental footprint of health care facilities.
Technical Assistance and Services Center
Web site
Provides technical assistance to states that administer the Medicare Rural Hospital Flexibility Program supporting Critical Access Hospitals (CAHs). TASC works under a cooperative agreements with HRSA-ORHP to provide relevant, customized technical assistance, tools, resources, and information, many of which can be found on its website.
Workflow Assessment for Health IT Toolkit
Web site
Assists people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care to conduct a workflow analysis and redesign before, during, and after health information technology implementation.
Regulations, Forms & Other Useful Documents
2011 Flex Coordinator Manual
Sponsoring organization: Technical Assistance and Services Center
Resource for current Flex Program staff as well as an orientation manual for new staff.
Date: 2011
Best Practices & Success Stories: A Guidebook for Medicare Rural Hospital Flexibility Program Coordinators
Sponsoring organization: National Rural Health Resource Center
Draws on the experiences and advice of some of the more experienced Flex Coordinators to provide practical strategies and advice to help their fellow Flex Coordinators succeed in managing a State Flex Program.
Date: 04 / 2010
CAH Financial Indicators Report: Summary of Indicator Medians by State, 2011
Sponsoring organization: Flex Monitoring Team
Presents 20 financial indicators for Critical Access Hospitals (CAHs). Includes state and national medians for indicators addressing profitability, liquidity, capital structure, revenue, cost, and utilization.
Date: 08 / 2011
Capital Investment Needs of CAHs: Fire and Life Safety Code Compliance and Organizational Performance
Author(s): Walter Gregg
Sponsoring organization: Flex Monitoring Team
Describes current CAH capital needs and their experiences obtaining the capital critical for remaining compliant with fire and life safety codes and essential for maintaining effective and efficient operations.
Date: 11 / 2008
Capital Investment Needs of Critical Access Hospitals (CAHs): Results of the 2007 National CAH Survey
Author(s): Walter Gregg
Sponsoring organization: Flex Monitoring Team
Describes the findings of a national telephone survey of CAHs to determine the nature of their capital needs and experiences in accessing capital to meet those needs.
Date: 02 / 2009
Changes in Obstetrical Services Among Critical Access Hospitals
Author(s): Mark Holmes, Saleema Karim, George Pink
Sponsoring organization: Flex Monitoring Team
Study identifies any change in the provision of obstetrical services by CAHs and to determine whether changes could be explained by particular factors facing CAHs.
Date: 03 / 2011
CMS State Operations Manual: Appendix W - Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs) and Swing-Beds in CAHS
Sponsoring organization: Centers for Medicare and Medicaid Services
Detailed information about the state survey process for Critical Access Hospitals (CAHs).
Date: 12 / 2011
Code of Federal Regulations: 42 CFR 485.601-645: Subpart F, Conditions of Participation: Critical Access Hospitals (CAHs)
Sets forth the conditions that a hospital
must meet to be designated as a Critical Access Hospital (CAH).
Community Benefit Activities of Critical Access Hospitals, Non-Metropolitan Hospitals and Metropolitan Hospitals
Author(s): Melanie Race, John Gale, Andrew Coburn
Sponsoring organization: Flex Monitoring Team
A comparison of CAHs to non-metropolitan non-CAHs (non-metro hospitals) and metropolitan (metro) hospitals using a set of community benefit indicators developed by the Flex Monitoring Team (FMT).
Date: 03 / 2010
Community Benefit Reporting Toolkit for Critical Access Hospitals
Sponsoring organization: Flex Monitoring Team
Provides guidance to the staffs of Critical Access Hospitals (CAHs) in collecting and reporting community benefit data to comply with federal and/or state community benefit reporting requirements or to prepare community benefit reports for internal and external audiences.
Date: 10 / 2009
Community Benefits of Critical Access Hospitals: A Review of the Data
Author(s): Melanie Race, John Gale, Andrew Coburn
Sponsoring organization: Flex Monitoring Team
Examines the community benefit activities of Critical Access Hospitals (CAHs) using data from the Flex Monitoring Team’s (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service’s (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.
Date: 03 / 2010
Comparison of Rural Hospitals with Special Medicare Payment Provisions to Urban and Rural Hospitals Paid Under Prospective Payment (Final Report)
Author(s): G. Mark Holmes, George H. Pink, Sarah A. Friedman, Hilda A. Howard
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Compares the financial performance and condition of rural hospitals with special Medicare payment provisions to urban and rural hospitals paid under prospective payment (U-PPS and R-PPS hospitals, respectively).
Date: 08 / 2010
Critical Access Hospital Prototype
Sponsoring organization: Health Resources and Services Administration
Provides guiding principles to assist hospitals in the planning, design, construction, and development of a CAH replacement facility.
Date: 2005
Critical Access Hospital Replacement Process: The Manual
Sponsoring organization: U.S. Department of Health and Human Services
Provides a comprehensive picture of the facility replacement process. Discusses the phases, events, actions, and involved parties that are needed. Provides practical guidance on the facility replacement process, including assessing the CAH’s physical and financial situation, gaining community support, identifying and obtaining financing, working with lenders and Federal enhancement programs, and completing the design and construction process.
Date: 10 / 2010
Critical Access Hospital Replacement Process: The Roadmap
Sponsoring organization: U.S. Department of Health and Human Services
Provides a visual overview of the entire facility replacement process. Divided into four phases including Planning, Design and Financing, Endorsement, and Construction. Each phase is further described by events, actions, duration, costs/fees, and involved parties.
Date: 10 / 2010
Critical Access Hospital Year 6 Hospital Compare Participation and Quality Measure Results
Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Examines 2009 participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures.
Date: 04 / 2011
Critical Access Hospitals (CAHs): Distance from Other Providers and Relocation of CAHs with a Necessary Provider Designation
Sponsoring organization: Centers for Medicare and Medicaid Services
September 7, 2007 letter from CMS to State Survey Agency Directors. Explains the criteria to determine whether a Critical Access Hospital (CAH) applicant satisfies the regulatory requirement. Explains the criteria to determine whether a
CAH with a necessary provider designation remains essentially the same provider, serving the same service area after relocation. Supersedes the November 14, 2005 guidance on this topic.
Date: 09 / 2007
Critical Access Hospitals and Financial Benchmark Performance
Author(s): George Pink, Mark Holmes, Rebecca Slifkin
Sponsoring organization: Flex Monitoring Team
Presents the results of application of the benchmarks to recent Critical Access Hospital (CAH) data. Very few CAHs performed better than benchmark on all five indicators in both 2004 and 2006.
Date: 11 / 2009
Critical Access Hospitals and Meaningful Use of Health Information Technology
Author(s): Jeffrey McCullough, Michelle Casey, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Assesses the availability of health information technology applications that are preconditions for meaningful use in CAHs, compared to other U.S. hospitals in 2008.
Date: 02 / 2010
Critical Access Hospitals' Experience with Medicare Advantage Plans
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans.
Date: 03 / 2008
Critical Access Hospitals: 340B Eligibility, Enrollment, and Participation
Sponsoring organization: Health Resources and Services Administration
Provides eligible Critical Access Hospitals and other interested parties basic background information about the 340B Drug Pricing Program and instructions on how to enroll in 340B.
Date: 08 / 2010
Critical Access Hospitals: The Value of Membership in the American Hospital Association
Author(s): AHA Section for Small or Rural Hospitals
Sponsoring organization: American Hospital Association
Describes the benefits of membership in the American Hospital Association (AHA) for Critical Access Hospitals (CAHs). Includes information on AHA's work in the areas of representation, advocacy, and policy development. Also discusses member benefits for hospitals.
Date: 2007
Developing Indicators to Document the Community Impact of Critical Access Hospitals
Author(s): John A. Gale, Jennifer Lenardson, Andrew Cobum, Melanie Race
Sponsoring organization: Flex Monitoring Team
Provides tools for Critical Access Hospitals to strategically manage, monitor, and report their community impact activities.
Date: 05 / 2008
Developing Regional STEMI Systems of Care: A Review of the Evidence and the Role of the Flex Program
Author(s): John A. Gale
Sponsoring organization: Flex Monitoring Team
Discusses the evidence base for the development of regional systems of care for patients presenting with ST-segment elevation myocardial infarction (STEMI) and can serve as a tool for State Flex Programs in the development of these local and regional systems of care.
Date: 10 / 2011
Doing Ethics in Rural Health Care Institutions
Author(s): Jacqueline J. Glover
Sponsoring organization: Board of Trustees of Dartmouth College
This fourth chapter of "Handbook for Rural Health Care Ethics," provides basic information about ethics and ethics deliberation and the challenges to ethics deliberation in rural areas. Provides a model template for ethical decision-making plus three mechanisms for supporting ethics deliberation.
Date: 2009
Evaluation of the Flexibility Critical Access Hospital Health Information Technology Network Implementation Program
Sponsoring organization: Health Resources and Services Administration
Summarizes the outcome of a $25 million in one-time funding to support 16 rural grantees to develop and implement health information technology pilot networks.
Date: 12 / 2010
Evidence-based Falls Prevention in Critical Access Hospitals
Author(s): Karen B. Pearson, Andrew F. Coburn,
Sponsoring organization: Flex Monitoring Team
Policy brief identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs.
Date: 12 / 2011
Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
Author(s): Janet P. Sutton, June Eichner
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Examines the experiences of Critical Access Hospitals in operating an emergency medical services (EMS) unit. Discusses the benefits and challenges that CAH providers face in operating EMS services.
Date: 10 / 2008
Fact Sheet: Critical Access Hospital
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Payment Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact CAHs; and grants to states under the Medicare Rural Hospital Flexibility Program.
Date: 04 / 2009
Final HIT Incentive Rule Stage 1 Quality Metrics Objective Summary and Challenge Identification
Author(s): Beth Dibbert, Louis Wenzlow
Sponsoring organization: Wisconsin Office of Rural Health
Serves as the first in a series of reports intended to help rural community hospitals develop strategies to meet the meaningful use objectives, then utilize the data to achieve process and quality improvement.
Date: 09 / 2010
Financial Comparison of Rural Hospitals With Special Medicare Payment Provisions to Hospitals Paid Under Prospective Payment (Findings Brief)
Author(s): George H. Pink, Rebecca T. Slifkin, Hilda A. Howard
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Compares the profitability of hospitals with the four classifications of rural hospitals that can qualify for special payment provisions under Medicare (Critical Access Hospitals, Medicare Dependent Hospitals, Sole Community Hospitals, and Rural Referral Centers) to urban and rural hospitals paid under prospective payment over a recent three-year period.
Date: 04 / 2010
From Hospitals to Healthcare Coalitions: Transforming Health Preparedness and Response in Our Communities
Sponsoring organization: U.S. Department of Health and Human Services
Summarizes progress that States and hospitals, along with the public health and emergency management communities made from 2007-2009 in the Hospital Preparedness Program (HPP). Serves as a guide in healthcare preparedness and response successful models and as an educational tool for legislators, funding recipients and other key stakeholders.
Guide to Financing Strategies for Hospitals: With Special Consideration for Smaller Hospitals
Sponsoring organization: Health Research & Educational Trust
Explores seven strategies that help hospitals achieve the good capital access. Provides considerations related specifically to smaller organizations, such as rural hospitals, critical access hospitals, and stand-alone community hospitals.
Date: 12 / 2010
Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward
Author(s): Eric Toner, Richard Waldhorn, Crystal Franco, Brooke Courtney, Kunal Rambhia, Ann Norwood, Thomas V. Inglesby, Tara O’Toole
Sponsoring organization: U.S. Department of Health and Human Services
Reports on the status of the Hospital Preparedness Program, which is designed to increase the ability of hospitals and healthcare systems to prepare for and respond to bioterror attacks on civilians and other public health emergencies, including pandemic influenza and natural disasters. Includes information on Critical Access Hospitals and rural areas.
Date: 03 / 2009
Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services
Author(s): Julie A. Schoenman, Janet P. Sutton
Sponsoring organization: NORC Walsh Center for Rural Health Analysis
Examines pre and post conversion data for hospitals that became CAHs during the first three years of the Flex Program in order to understand how CAH conversion affects not only hospital finances, but also inpatient service mix.
Date: 08 / 2008
Importance of Community Partnerships
Sponsoring organization: American Hospital Association
Spotlights hospitals and health systems that have successfully collaborated with local community organizations to promote care coordination, wellness, and prevention. Among the entities featured include rural hospitals and community health centers.
Date: 12 / 2010
Improving Hospital Patient Safety through Teamwork: The use of TeamSTEPPS in Critical Access Hospitals
Author(s): Andrew Coburn, Zach Gage-Croll
Sponsoring organization: Flex Monitoring Team
Provides information on how state Flex programs and CAH's have successfully adapted and used TeamSTEPPS to improve patient safety through team training.
Date: 06 / 2011
Innovators' Guide to Navigating CMS
Sponsoring organization: Centers for Medicare and Medicaid Services
Assists stakeholders in understanding the processes used to determine coverage, coding, and payment for new technologies under the Medicare fee-for-service program. Guide is intended as a general summary.
Date: 2010
Lessons Learned from Electronic Health Record Implementation at Three North Dakota Critical Access Hospitals
Sponsoring organization: JSI Research and Training Institute
Highlights common successes and challenges experienced during an electronic health
record (EHR) implementation project involving three Critical Access Hospitals (CAHs) in North Dakota. Offers recommendations for future Health Information Technology implementation processes.
Date: 03 / 2009
Manual on Effective Collaboration Between Critical Access Hospitals and Federally Qualified Health Centers
Sponsoring organization: U.S. Department of Health and Human Services
Highlights how through cooperation and collaboration, CAHs and FQHCs, especially those near each other and serving similar communities, can meet community needs, enhance roles, and stabilize and expand needed services and rural delivery systems.
Date: 04 / 2010
Meaningful Use and Critical Access Hospitals: A Primer on HIT Adoption in the Rural Health Care Setting
Sponsoring organization: U.S. Department of Health and Human Services
Provides CAHs with an introduction on HIT adoption issues and considerations, and identifies questions that can help CAHs define their own roadmap for adoption. Topics include evaluating organizational readiness, assembling multidisciplinary teams, reviewing current processes, identifying goals and objectives, and addressing vendor and product selection.
Date: 12 / 2010
Medicare Billing Information for Rural Providers and Suppliers
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides Medicare billing charts and information on where to submit claims for Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Skilled Nursing Facilities, Home Health Agencies, Critical Access Hospitals, and Swing Bed services.
Date: 09 / 2011
Medicare Payment Basics: Critical Access Hospitals Payment System
Sponsoring organization: Medicare Payment Advisory Commission
Presents an overview of how Critical Access Hospitals (CAHs) are paid by Medicare. Compares differences in Medicare payments for CAHs, Sole Community Hospitals (SCHs), and Medicare-dependent Hospitals (MDHs).
Date: 10 / 2011
Medicare Shared Savings Program: Accountable Care Organizations, Final Rule
Sponsoring organization: American Academy of Family Physicians
Summarizes segments of the rule on Medicare Accountable Care Organizations (ACOs) as they affect family practitioners in small- and medium-sized practices, including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and Critical Access Hospitals (CAHs).
Date: 11 / 2011
MedPAC Report to Congress: Regional Variation in Service Use, January 2011
Sponsoring organization: Medicare Payment Advisory Commission
Presents data on the difference between regional variation in Medicare spending and regional variation in the use of Medicare-covered services. Data used was adjusted due to differences in small rural hospital and critical access hospital Medicare payment rates.
Date: 01 / 2011
Models For Quality Improvement In Critical Access Hospitals: The Role Of State Flex Programs
Sponsoring organization: Flex Monitoring Team
Examines the range of multi-Critical Access Hospital (CAH) quality improvement and performance measurement reporting (QI) initiatives supported by the Medicare Rural Hospital Flexibility Program in nine states; assessed the role of State Flex Programs in developing and supporting these initiatives; and explored their impact on the QI programs of CAHs.
Date: 03 / 2010
Monitoring the Community Benefits of Critical Access Hospitals: A Review of the Data
Author(s): Melanie Race, John Gale, Andrew Coburn
Sponsoring organization: Flex Monitoring Team
Brief examines the community benefit activities of Critical Access Hospitals (CAHs) using data from the Flex Monitoring Team’s (FMT) pilot test of a set of community benefit data collection tools and performance indicators, the Internal Review Service’s (IRS) 2006 Hospital Compliance Study, and the 2007 FMT CAH survey.
Date: 03 / 2010
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Appendices and Addenda
Sponsoring organization: Health Resources and Services Administration
Represents the views of certain members of the Negotiated Rulemaking (NRM) Committee with information in support of several key Committee decisions related to the designation process presented in the full Committee report.
Date: 10 / 2011
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Appendices and Addenda: Attachments
Sponsoring organization: Health Resources and Services Administration
Contains supportive material for developing recommendations and influencing methodologies used to determine medically underserved populations (MUPs) and health professional shortage areas (HPSAs) as presented in the full Negotiated Rulemaking (NRM) Committee report.
Date: 10 / 2011
Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Final Report to the Secretary
Sponsoring organization: Health Resources and Services Administration
Contains recommendations and documentation of the Negotiated Rulemaking (NRM) Committee to influence methodologies used to determine medically underserved populations (MUPs) and health professional shortage areas (HPSAs).
Date: 10 / 2011
New Project Targets CAH Quality Measures and Reporting
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Discusses MBQIP, the Flex Medicare Beneficiary Quality Improvement Project, which is helping Critical Access Hospitals improve patient care quality and operations, and more accurately report rural health care quality.
Journal citation: Rural Monitor
Date: 11 / 2011
North Dakota Critical Access Hospital Quality Network Evaluation Executive Summary
Author(s): Brad Gibbens
Sponsoring organization: University of North Dakota Center for Rural Health
Presents a summary of the North Dakota CAH Quality Network's evaluation, activities, and accomplishments from 2008-2010.
Date: 12 / 2010
Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
Author(s): Andrew F. Coburn, Jennifer P. Lundblad, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
Date: 09 / 2010
Pneumonia Quality Improvement Programs and Strategies in Critical Access Hospitals
Author(s): Michelle Casey, Jill Klingner, Shailendra Prasad, Walter Gregg
Sponsoring organization: Flex Monitoring Team
Discusses several QI strategies which have been shown to improve pneumonia care and may be replicable in CAHs. Includes a reference table to help in determining which strategies may be useful for implementation in hospitals.
Date: 06 / 2011
Potential Impact of Pay-for-Performance on the Financial Health of Critical Access Hospitals (Policy Brief)
Author(s): Robert Town, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Pay-for-performance (P4P) incentives likely reduce the financial status of CAHs already
in financial stress. However, P4P incentives are likely to have only a modest impact on the financial stability of CAHs.
Date: 02 / 2010
Prepared to Care: The 24/7 Role of America's Full-service Hospitals
Sponsoring organization: American Hospital Association
Describes three roles hospitals play: 24/7 access to care, the safety net, disaster readiness and response and how important these are to the health and public safety or both rural and urban areas. Summarizes financial pressures and policy questions to address in order for hospitals to maintain their standby capacity and continue meeting health and public safety challenges.
Date: 2006
Providing Underserved Patients with Medical Homes: Assessing the Readiness of Safety-Net Health Centers
Author(s): Katie Coleman, Kathryn Phillips
Sponsoring organization: Commonwealth Fund
Surveys safety-net health centers (public hospitals and clinics, federally qualified health centers, rural health centers, and free clinics for the medically underserved) to determine their potential to become patient-centered medical homes (PCMHs).
Date: 05 / 2010
Provision of Long Term Care Services by Critical Access Hospitals: Are Things Changing?
Author(s): Melanie Race, John Gale, Andrew Coburn,
Sponsoring organization: Flex Monitoring Team
Discusses trends in access to post-acute and long term care (LTC) services in rural areas and the roles Critical Access Hospitals play.
Date: 03 / 2011
Raising Funds for Rural Health Care: An Introductory Manual
Sponsoring organization: Technical Assistance and Services Center
Provides the basics for establishing a structured process of ongoing philanthropic resource development for health care facilities.
Relevant Quality Measures for Critical Access Hospitals
Author(s): Michelle Casey, Ira Moscovice, Jill Klingner, Shailendra Prasad
Sponsoring organization: Flex Monitoring Team
Policy brief describes quality measures relevant to Critical Access Hospitals (CAHs) and identifies policy implications.
Date: 01 / 2012
Risk of Financial Distress Among Critical Access Hospitals: A Proposed Model
Author(s): Mark Holmes, George H. Pink,
Sponsoring organization: Flex Monitoring Team
Presents a model to predict the financial distress of CAHs that can be used by administrators and state program officers as an
early warning system to identify hospitals at increased risk of facing financial distress.
Date: 04 / 2011
Role of State Flex Programs in Supporting Quality Improvement in Critical Access Hospitals
Author(s): Andrew Coburn, John Gale, Melanie Race, Mark Richards, Anush Hansen
Sponsoring organization: Flex Monitoring Team
Reports that the Flex Program has been instrumental in funding and providing leadership for the development of Critical Access Hospital (CAH) quality improvement initiatives.
Date: 04 / 2010
Rural Health Networks Prove There is Strength in Numbers
Author(s): Candi Helseth
Sponsoring organization: Rural Assistance Center
Discusses how quality is increasing measurably for hospitals enrolled in rural health networks in Michigan and Montana.
Journal citation: Rural Monitor
Date: 11 / 2011
Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
Author(s): Jill Klingner, Ira Moscovice
Sponsoring organization: Flex Monitoring Team
Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State.
Date: 03 / 2007
Rural Hospital Replacement Facility Study, 2010 Part 1: Community Profiles
Sponsoring organization: Stroudwater Associates
Summarizes the results of a study that examined the make-up of the communities that have successfully completed a replacement facility for their rural hospital.
Date: 2010
Rural Hospital Replacement Facility Study, 2010 Part 2: In Good Times and Bad
Sponsoring organization: Stroudwater Associates
Summarizes the results of a study that analyzed the impact of replacement on rural hospitals’ volume, financial, and operational
performance.
Date: 2010
Rural Hospital Support for Emergency Medical Services (Findings Brief)
Author(s): Victoria A. Freeman, Hilda A. Howard, Ruth Lavergne
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Uses Medicare Hospital Cost Reports to identify rural hospitals, with and without Emergency Medical Services (EMS) units, to answer the following questions: what proportion of rural hospitals support or operate EMS units; has this changed in last five years; what are the characteristics of rural hospitals that support or operate EMS; what are the financial investments made by these hospitals in EMS; and what describes the communities in which these hospitals are located.
Date: 11 / 2010
Rurals at a Crossroads
Author(s): Susan Stowell, James Puiia
Sponsoring organization: Health Forum
Offers leaders of rural hospitals ways to assess opportunities and develop strategies that will enable their hospitals to remain relevant during and following the redesign of the health care delivery system.
Date: 01 / 2011
State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into the Trauma System (Briefing Paper)
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Sponsoring organization: Flex Monitoring Team
Provides information on State Flex Program EMS and trauma-related activities. Focuses on the designation of Critical Assess Hospitals as trauma centers.
Date: 03 / 2010
State Flex Program EMS/Trauma Activities and Integration of Critical Access Hospitals into the Trauma System (Policy Brief)
Author(s): Walter Gregg, Nicholas Jennings, Christopher Dickerson
Sponsoring organization: Flex Monitoring Team
Reports that more than one-third of all Critical Access Hospitals in the U.S. have been designated as trauma centers. The project team identified a combined total of 560 CAHs designated as trauma centers.
Date: 03 / 2010
States' Use of Cost-Based Reimbursement for Medicaid Services at Critical Access Hospitals
Author(s): Andrea Radford, Mike Hamon, Caitlin Nelligan
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Critical Access Hospitals (CAH) are reimbursed by Medicare at 101% of allowable cost for both inpatient and outpatient services. State Medicaid agencies however are not required to reimburse CAHs on a cost-basis and have flexibility in determining how CAHs are paid for providing services to Medicaid enrollees. This brief documents which states utilize a cost-based reimbursement methodology for Medicaid.
Date: 04 / 2010
Summary of Health Information Technology Incentives and Resources
Sponsoring organization: National Rural Health Resource Center
Summarizes the Medicare and Medicaid incentives available to eligible professionals and hospitals for the implementation of certified electronic health record (EHR) technology. Included are definitions, information on meaningful use, certified technology, and helpful health information technology resources.
Date: 02 / 2011
Swing Bed Services: Rural Health Fact Sheet Series
Sponsoring organization: Centers for Medicare and Medicaid Services
Provides information about the requirements Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds, as needed, to provide either acute or Skilled Nursing Facility care.
Date: 11 / 2011
Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Final Report)
Author(s): Kristin L. Reiter, Victoria A. Freeman
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Provides descriptive evidence on current trends in the availability and use of swing beds and skilled nursing facility services in rural areas.
Date: 04 / 2011
Value-Based Purchasing and Critical Access Hospitals: Summary of Recommendations
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
Summarizes recommendations from the Rural Health Panel's report, CMS Value-Based Purchasing Program and Critical Access Hospitals.
Journal citation: RUPRI Rural Policy Brief
Date: 01 / 2009
Value-Based Purchasing Demonstrations for Critical Access and Small PPS Hospitals
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
Recommendations to the Secretary of HHS on the rural implications of the ACA provision on inpatient hospital Value-Based Purchasing (VBP) program.
Date: 09 / 2011
Terms & Acronyms
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Co-location Different health units, such as a CAH and a FQHC, situated on the same site sharing resources and facilities.
Cost-based Reimbursement Method of reimbursing medical services based on the total costs incurred providing services to a patient.
Critical Access Hospital (CAH) Rural hospitals with fewer than 25 acute care beds located at least 35 miles, or 15 by mountainous terrain or secondary roads, from the nearest hospital unless designated as a “Necessary Provider” by a state plan.
DRG (Diagnosis-related Groups) Reimbursement method where the hospital receives a fixed payment for each type of medical procedure, regardless of the hospital's cost.
Fiscal Intermediary (FI) Company designated by CMS to process claims and make payment for services.
Meaningful Use Refers to the meaningful use of certified electronic health record technology to achieve certain healthcare quality, safety, and efficiency goals. Eligible professionals, hospitals, and critical access hospitals must attest that they've met their respective meaningful use criteria and are eligible to receive Medicare incentive payments for the installation and use of electronic health record systems under the American Recovery and Reinvestment Act of 2009.
Medicare Conditions of Participation (CoP) CMS conditions that health care organizations must meet to participate in the Medicare and Medicaid programs. Used to improve quality and protect the health and safety of beneficiaries.
Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) Legislation passed in 2003 that included significant Medicare reforms including a prescription drug benefit for Medicare beneficiaries and reimbursement improvements for rural healthcare facilities.
Medicare Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.
Medicare Rural Hospital Flexibility Program (Flex Program) Federal initiative created by the Balanced Budget Act of 1997 that provides funding to State Governments to strengthen rural health. Requires the development of state rural health plan. Provides funding to States network development, quality improvement, designation of Critical Access Hospitals (CAHs), and improvement of rural EMS.
PIP (Periodic Interim Payment) A regular payment made to a Critical Access Hospital based on an estimate of annual revenue to help maintain cash flow until cost reports from the current cost reporting period are settled and an annual payment adjustment is made.
Quality Improvement Organization (QIO) QIOs review Medicare services. They work with consumers, physicians, hospitals, and other caregivers to make sure patients get the right care at the right time, particularly among underserved populations.
Swing beds Licensed acute-care beds designated by a hospital to provide either acute or long-term care services. A swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital skilled nursing facility care and meets certain requirements.
TASC (Technical Assistance and Services Center) The technical assistance center for the Medicare Rural Hospital Flexibility Program (Flex Program). Provides information, tools and resources on all aspects of the Flex Program, including CAH, networking, EMS, and quality improvement. TASC is run by the Rural Health Resource Center in Duluth, MN.
