Opportunities for Critical Access Hospitals
Since 2010, 81 rural hospitals have closed in the United States with another 673 at risk, endangering the health of individuals, families, and communities. Nearly 30 million people don’t live within an hour of trauma care. In fact, residents living in 16% of the mainland United States are 30 miles or more away from the nearest hospital. The rate of accidental deaths adjusted for age was nearly 50% higher in rural versus urban areas from 1999 to 2015 according to a CDC study, which also noted that long travel distances to specialty and emergency care placed residents at higher risk of death.
In response to rural hospital closures in the 1980s and early 1990s, the Critical Access Hospital (CAH) designation was created by Congress as part of the 1997 Balanced Budget Act, designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. Eligibility requirements for CAHs include 25 or fewer acute care inpatient beds; another hospital must be located more than 35 miles away; the facility must maintain an average length of stay of 96 hours or less for acute care patients; and the hospital must provide 24/7 emergency care services.
Today, Critical Access Hospitals are in 45 states. Many of these hospitals are the largest employer in their community, and each offers services and programs customized to area residents’ needs. For example, one hospital partners with their state government to provide vaccinations to children, another offers hip replacement surgery, and yet another conducts surgery for patients using the latest robotic equipment. Local rural hospitals develop very close relationships with their patients, providing hands-on care. One CAH executive shared with me how their hospital employees pushed an elderly patient in a wheelchair through the snow from a nearby clinic for care.
Despite having CAH designations, cuts to reimbursements and potential federal policy modifications, including proposed changes to Medicaid, intensify rural hospitals’ risk of closure. With 1 out of 5 people living in rural areas, CAHs serve a vital role in the health of their communities.
The Critical Access Hospital Coalition advocates on behalf of vulnerable CAHs located throughout the United States by proposing policy changes and regulatory adjustments that would benefit these essential facilities. Recently, in the wake of Hurricane Harvey, the Centers for Medicare and Medicaid Services announced that it will waive certain requirements for hospitals providing care, allowing lengths of stay beyond the capped 96-hour period and waiving the 25-bed limit for CAH designation. This type of relief is welcome to CAHs and rural communities.
About the Critical Access Hospital Coalition
The Critical Access Hospital Coalition (CAH Coalition) is a consortium of innovative healthcare leaders representing CAHs nationwide. Its sole purpose is to assist policy makers in understanding the unique needs of CAHs so that quality healthcare is sustained in rural communities. For more information, visit the CAH Coalition website.
Guest blogger: Audrey Smith, Critical Access Hospital Coalition Executive Director