Critical access hospitals (CAHs) recorded higher rates of hospital transfers after surgery though the percentage of patients who used post acute care was similar to those treated at non-CAHs, a new study reveals.
The CAH designation was created to provide financial support to rural hospitals. As such, they are exempt from Medicare's Prospective Payment System and instead are paid cost-based reimbursement. The proliferation of CAHs after the payment policy change has increased interest in the quality and cost of care these facilities provide.
The authors used data from the Nationwide Inpatient Sample and the American Hospital Association to examine patients undergoing six common surgical procedures (hip and knee replacement, hip fracture repair, colorectal cancer resection, gall bladder removal and transurethral resection of the prostate [TURP]) at CAHs or non-CAHs. The authors measured hospital transfer, discharge with post-acute care or routine discharge. The authors identified 4,895 acute-care hospitals reporting from 2005 through 2009: 1,283 (26.2 percent) of which had a CAH designation.
"These results will affect the ongoing deliberations concerning CAH payment policy and its implications for health care delivery in rural communities."
Author: Adam J. Gadzinski, M.D., M.S., of the University of Michigan Health System, Ann Arbor, Mich., and colleagues.
(JAMA Surgery. Published online May 14, 2014. doi:10.1001/jamasurg.2013.5694)
Editor's Note: Authors made conflict of interest disclosures. The research was supported by the Michigan Institute for Clinical & Health Research, the Agency for Healthcare Research and Quality and the Urology Care Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: The Right Triangle
In a related commentary, Matthew J. Resnick, M.D., and Daniel A. Barocas, M.D., M.P.H., of Vanderbilt University, Nashville, Tenn., write: "The article by Gadzinski and colleagues raises important questions about how best to maintain access to surgical care in underserved communities."
"There remains no obvious mechanism to ensure the financial viability of individual CAHs, particularly in the era of the integrated health care delivery system. Medicare will probably have to continue subsidizing these hospitals to maintain broad access to financially unsuccessful service lines; the challenge will be to keep the quality and cost corners of the triangle from growing too obtuse or acute."
(JAMA Surgery. Published online May 14, 2014. doi:10.1001/jamasurg.2013.5707.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.