Critical Access Hospitals and Rural Hospital Flexibility Program

Publications

Alphabetical list. You can also view by publication date.

• 2004 CAH Survey National Data
  Author(s): Michelle Casey, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Date: 08 / 2004
  As part of the monitoring efforts for the Medicare Rural Hospital Flexibility Program (Flex Program), the Flex Monitoring Team conducted a national telephone survey of 500 CAH administrators between January and April 2004. The purpose of the survey was to document the program-related experiences of CAHs over the past two years, in order to help shape public policy to improve the effectiveness of the Flex Program and CAHs. The CAH survey was developed by the Flex Monitoring Team members at the Universities of Minnesota, North Carolina, and Southern Maine and fielded by the Survey Research Center in the Division of Health Services Research and Policy at the University of Minnesota. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Analysis of CAH Inpatient Hospitalizations and Transfers: Implications for National Quality Measurement and Reporting
  Author(s): Michelle Casey, Michele Burlew
  Research center: Upper Midwest Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 13
  Date: 12 / 2006
  Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• At-Risk Hospitals: The Role of Critical Access Hospital Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Author(s): Kathleen Dalton, Rebecca Slifkin, Hilda Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Prospective Payment System (PPS)
  Date: 02 / 2000
  This report examines not-for-profit hospitals that potentially qualify as Critical Access Hospitals and identifies those facilities that are at risk as a result of Medicare's PPS to non-acute care settings.
• Availability and Use of Capital by Critical Access Hospitals
  Author(s): Walter Gregg
  Research center: Minnesota Rural Health Research Center
  Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 4
  Date: 03 / 2005
  Examines the experiences of Critical Access Hospitals (CAHs) in meeting their capital needs. It focuses specifically on their efforts to obtain capital, the capital sources tapped through these efforts, how CAHs have used the capital they have been able to obtain over the past few years, and assesses their current capital needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Capital funding, Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 1
  Date: 10 / 2005
  Summarizes Critical Access Hospital (CAH) financial indicators for 2003, providing state and national medians for each indicator. The indicators are grouped by financial dimension: profitability, liquidity, capital structure, revenue, cost, and utilization. The number of CAHs included in the median calculations is also provided. Information about the definition and interpretation of the indicators can be found in the full report, Briefing Paper No. 7, Financial Indicators for Critical Access Hospitals. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Date: 08 / 2007
  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. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Financial Indicators Report: Summary of Indicator Medians by State
  Author(s): CAH Financial Indicators Report Team at UNC
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Data Summary Report No. 2
  Date: 11 / 2006
  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. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• CAH Participation in Hospital Compare and Initial Results
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 9
  Date: 02 / 2006
  Examines the participation of Critical Access Hospitals (CAHs) in public reporting of quality measures in the Centers for Medicare and Medicaid Services Hospital Compare database. It presents the initial Hospital Compare results for CAHs and comparisons with other groups of hospitals on quality measures for three conditions: acute myocardial infarction (heart attack), heart failure and pneumonia. Although CAHs do not face the same financial incentives as Prospective Payment System hospitals to participate, the Hospital Compare initiative provides an important opportunity for CAHs to assess and improve their performance on national standards of care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Community Impact of Critical Access Hospitals
  Author(s): John A. Gale, Andrew F. Coburn, Victoria Freeman, Walter R. Gregg, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Policy Brief No. 2
  Date: 02 / 2007
  Discusses the findings of a project to understand the community involvement and impact of Critical Access Hospitals (CAHs) and the Medicare Rural Hospital Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Community Involvement of Critical Access Hospitals: Results of the 2004 National CAH Survey
  Author(s): Stephanie Poley, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 6
  Date: 03 / 2005
  The data reported here provide a starting point for understanding Critical Access Hospital (CAH) community involvement. Data were collected and analyzed from a national telephone survey of CAH administrators conducted in 2004. Survey respondents were asked about community involvement activities including community needs assessment, outreach and formal health promotion programs, relationships with other community organizations, free or reduced cost health care, and hospital activities in support of special populations. Most CAHs are engaged in activities that offer benefit to their community beyond hospital-based acute care services. Administrators recognize the importance of being responsive to community needs and seek the financial support necessary to maintain outreach activities. The outreach programs reported by CAH administrators resemble typical community activities for a health care facility, with a particular emphasis on health promotion and management of chronic conditions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Comparative Performance Data for Critical Access Hospitals
  Author(s): George H. Pink, Rebecca T. Slifkin, Andrew F. Coburn, John A. Gale
  Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Citation: Journal of Rural Health, 20(4), 374-382
  Date: 2004
  Discusses the potential use of comparative performance data for critical access hospitals (CPD-CAH) to facilitate performance and quality improvement. Covers potential benefits and drawbacks of CPD-CH and identifies issues in the development and implementation of CPD-CAH.
• Contracting with Medicare Advantage Plans: A Brief for Critical Access Hospital Administrators
  Author(s): Michelle Mason, Roslyn Fraser-Maginn, Keith Mueller, Jennifer King, Andrea Radford, Rebecca Slifkin, Jennifer Lenardson, Lauren Silver, Curt Mueller
  Research centers: North Carolina Rural Health Research and Policy Analysis Center, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Advantage (MA)
  Date: 12 / 2005
  Summarizes the experience of Critical Access Hospital (CAH) administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue.
• Creating Program Logic Models: A Toolkit for State Flex Programs
  Author(s): John Gale, Stephenie Loux, Andrew Coburn
  Research center: Maine Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Date: 04 / 2006
  Provide states with a tool for planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments; assistance in identifying and defining measurable outcomes; information linking state-level Flex Program strategies to specific and measurable outcomes; and a consistent program-reporting framework to convey results to both internal and external stakeholders. The Program Logic Model (PLM) Toolkit is organized according to the steps in the PLM development process and guides the user through each section. Included in the Toolkit is an overview of PLMs, their component parts, and the application of the PLM framework to the planning, implementation, and evaluation of the Flex Program. The bulk of the Toolkit provides a step-by-step approach to developing a Program Logic Model. The final section of the Toolkit lists resources for additional information on PLMs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Patient Safety Priorities and Initiatives: Results of the 2004 National CAH Survey
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Briefing Paper No. 3
  Date: 09 / 2004
  Describes the patient safety results from a national phone survey of 474 CAH administrators conducted in 2004. Survey respondents were queried regarding top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. The survey findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously because of the significant number of CAHs which reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 16
  Date: 04 / 2007
  Examines the second year 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. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospital Year 2 Hospital Compare Participation and Quality Measure Results (Policy Brief)
  Author(s): Michelle Casey, Michele Burlew, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Policy Brief No. 4
  Date: 05 / 2007
  Policy brief examining the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database. A full report is also available. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Critical Access Hospitals' Experience with Medicare Advantage Plans
  Research centers: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis, Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Hospitals and clinics, Medicare Advantage (MA)
  Date: 03 / 2008
  This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans. Findings from this research identify concerns of CAH administrators that, as the MA program evolves, may be addressed through technical assistance and changes in regulation or legislation.
• Current Status of Health Information Technology Use in CAHs
  Author(s): Michelle Casey, Jill Klingner, Walt Gregg, Ira Moscovice, Emily Nicholson, Tami Lichtenberg, Terry Hill
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health information technology
  Report Number: Briefing Paper No. 11
  Date: 05 / 2006
  Both the public and private sectors have focused considerable attention on health information technology (HIT) as a potential means of improving the quality, safety, and efficiency of health care. The purpose of this briefing paper is to assess the current status of HIT use in Critical Access Hospitals (CAHs) nationally. This project is part of the federal Office of Rural Health Policy's initiative to implement national performance measures for the Medicare Rural Hospital Flexibility Program. It was conducted by the Flex Monitoring Team in collaboration with the Technical Assistance and Services Center (TASC) at the Rural Health Resource Center in Duluth, Minnesota. Data for the study came from a national survey of CAHs conducted in March and April 2006. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program
  Author(s): P. Daniel Patterson, John A. Gale, Stephenie L. Loux, Anush E. Yousefian, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Report Number: Flex Monitoring Team Briefing Paper No. 8
  Date: 02 / 2006
  Describes the EMS related activities that the 45 states receiving funding from the Medicare Rural Hospital Flexibility (Flex) Program proposed to conduct in fiscal year 2004-2005. Since the first full year of funding, the number and range of EMS improvement activities proposed has increased substantially states' proposals contained 239 documented EMS improvement activities. Of these, 40% focused on the Integration of Health Services attribute, 13% on Human Resource challenges, and 13% on Education Systems. Continued support of activities begun prior to 2004 was common. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Exploring the Community Impact of Critical Access Hospitals
  Author(s): John Gale, Andrew Coburn, Walt Gregg, Rebecca Slifkin, Victoria Freeman
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Flex Monitoring Team Briefing Paper No. 14
  Date: 01 / 2007
  Reports on a series of site visits to six diverse rural communities and Critical Access Hospitals (CAHs) to assess the experiences and impact of these hospitals in responding to their community’s health infrastructure needs. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Financial Benefits of Critical Access Hospital Conversion for FY 1999 and FY 2000 Converters
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Date: 01 / 2004
  Discusses the impact of conversion to Critical Access Hospital (CAH) status on the financial condition of rural hospitals one and two years after conversion. CAHs pre- and post-conversion revenues are compared, and CAH revenues are compared to small rural hospitals that did not convert to cost-based Medicare reimbursement.
• Financial Effects of Critical Access Hospital Conversion
  Author(s): Jeffrey Stensland, Gestur Davidson, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Date: 01 / 2003
  Describes how the first wave of conversions to Critical Access Hospital (CAH) status affected rural hospitals? financial performance and organizational structure.
• Financial Indicators for Critical Access Hospitals
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Briefing Paper No. 7
  Date: 05 / 2005
  The purpose of this study was to develop and disseminate comparative financial indicators specifically for Critical Access Hospitals (CAHs) using Medicare Cost Report data. Results showed that, over the six years since 1998, CAHs generally became more profitable and increased their utilization of beds. However, while on average CAHs with long-term care became more liquid and reduced their use of debt over time, those without long-term care became less liquid and increased their use of debt. In the most recent year for which we have data (2003), CAHs without long-term care generally were more profitable, were more liquid, had less debt, and had higher utilization of beds in comparison to CAHs with long-term care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Financial Indicators for Critical Access Hospitals
  Author(s): George H. Pink, G. Mark Holmes, Cameron D'Alpe, Lindsay A. Strunk, Patrick McGee, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Citation: Journal of Rural Health, 22(3), 229-36
  Date: 2006
  There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). The authors, along with a technical advisory group, focused on twenty indicators deemed appropriate for assessment of CAH financial condition and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form.
• Financial Viability of Rural Hospitals in a Post-BBA Environment
  Author(s): Jeffrey Stensland, Ira Moscovice, Jon Christianson
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Hospitals and clinics
  Date: 10 / 2000
  This paper evaluates the financial viability of rural hospitals under the Balanced Budget Act of 1997 (BBA) and the Balanced Budget Refinement Act of 1999 (BBRA) Medicare payment policies. Estimates the number of hospitals that will become Critical Access Hospitals (CAHs) and estimates the number of beds at each hospital.
• Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
  Author(s): Julie Schoenman and Janet Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Health services
  Date: 08 / 2008
  This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.
• Impact of Conversion to Critical Access Hospital Status on Hospital Financial Performance and Condition
  Author(s): Mark Holmes, George H. Pink, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Report Number: Flex Monitoring Team Findings Brief No. 1
  Date: 11 / 2006
  Policy brief analyzing financial ratios associated with Critical Access Hospitals' profitability, liquidity, and capital structure. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Intensive Care in Critical Access Hospitals
  Author(s): Victoria A. Freeman, Joan Walsh, Matthew Rudolf, Rebecca T. Slifkin, Asheley Cockrell Skinner
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Citation: Journal of Rural Health, 23(2), 116-123
  Date: 2007
  Describes the facilities, equipment, and staffing used by Critical Access Hospitals (CAHs) for intensive care, the types of patients receiving ICU care, and the perceived impact of closing the ICU on CAH staff and the local community.
• Mental Health Encounters in Critical Access Hospital Emergency Rooms: A National Survey
  Author(s): David Hartley, Erika Ziller, Stephenie Loux, John Gale, David Lambert, Anush Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Report Number: Working Paper No. 32
  Date: 09 / 2005
  Investigates the extent and types of cases that present with mental health problems in Critical Access Hospitals (CAHs) emergency rooms (ERs), as well as the resources available to ER staff for addressing such problems and what actually happens to such patients. Emergency department managers in a random sample of 422 CAHs in 44 states completed a telephone survey (response rate = 84.7%) responding to questions about prevalence of mental health problems in their ER and what options they had for responding to such problems. On average, CAHs had 99 emergency room visits per week. Of these visits, 9.4% were mental health related. CAH ERs play a significant role in providing mental health services to rural residents. Although nearly 20% of mental health encounters result in transfers to other facilities, over 40% of mental health problems are addressed on-site through treatment or referrals. Nearly half (43%) of CAH ER managers reported having no access to local mental health providers of any kind.
• Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention
  Author(s): Jiexin (Jason) Liu, Gail R. Bellamy, Melissa McCormick
  Research center: ORHP-funded Individual Grantees
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Citation: Journal of Rural Health, 23(1), 17-24
  Date: 2007
  Describes the results of a study to assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.
• Quality and Performance Improvement Grant Activities Under the Flex Program
  Author(s): Jennifer Lenardson, John Gale
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 12
  Date: 08 / 2006
  Describes quality and performance improvement activities proposed by states during the 2005 grant year under the Medicare Rural Health Flexibility Program (Flex Program). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Quality Improvement Activities in Critical Access Hospitals: Results of the 2004 National CAH Survey
  Author(s): Michelle Casey, Ira Moscovice, Jill Klingner
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Flex Monitoring Team Briefing Paper No. 2
  Date: 09 / 2004
  Describes quality improvement efforts in Critical Access Hospitals (CAHs) based on a 2004 survey of 474 CAH administrators. Includes data on the use of clinical guidelines and quality measures in CAHs, and the role of Medicare Quality Improvement Organizations (QIOs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Quality Improvement Strategies and Best Practices in Critical Access Hospitals
  Author(s): Michelle Casey, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Quality
  Report Number: Working Paper No. 52
  Date: 01 / 2004
  Describes Critical Access Hospital (CAH) quality improvement (QI) initiatives, with examples of best practices from two CAHs that have innovative QI programs. Includes lists of changes made to staffing, training, equipment and other issues related to quality improvement.
• Review of State Flex Program Plans, 2004-2005
  Author(s): Stephenie Loux, John Gale, Anush Yousefian, Andrew Coburn, Walter Gregg
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 10
  Date: 03 / 2006
  Examines the objectives and project activities proposed by states in their Medicare Rural Hospital Flexibility Program (Flex Program) grant applications for Fiscal Year 2004 to strengthen the rural healthcare infrastructure in their states. Highlights recent trends in State Flex Program planning, development, and implementation. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)
  Date: 01 / 2000
  Examines rural hospitals that potentially qualify as Critical Access Hospitals (CAH), and identifies facilities at substantial financial risk as a result of Medicare?s expansion of prospective payment systems (PPS) to non-acute settings.
• Role of International Medical Graduates in America's Small Rural Critical Access Hospitals
  Author(s): Amy Hagopian, Matthew J. Thompson, Emily Kaltenbach, L. Gary Hart
  Research center: WWAMI Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, International Medical Graduates (IMGs), Workforce
  Citation: Journal of Rural Health, 20(1), 52-58
  Date: 2004
  Descriptive report presenting the roles and characteristics of foreign-born international medical graduates (IMGs) in Critical Access Hospital (CAH) facilities and the opinions of the CEOs about these practitioners.
• Rural Hospital Emergency Department Quality Measures: Aggregate Data Report
  Author(s): Jill Klingner, Ira Moscovice
  Research center: Minnesota Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Quality
  Report Number: Flex Monitoring Team Data Summary Report No. 3
  Date: 03 / 2007
  Reports findings from a project that tested emergency department quality measures in a voluntary sample of critical access hospitals (CAHs) in Washington State. The quality measures that were tested focused on patients presenting to the emergency department with chest pain/acute myocardial infarction (AMI, or heart attack) or trauma, and patients seen in the emergency department who were transferred to another hospital for care. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Rural Hospital Flexibility Program: The Tracking Project Reports First-year Findings
  Author(s): Amy Hagopian, Gary L Hart, et al
  Research center: WWAMI Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Citation: Journal of Rural Health, 17(2), 82-86
  Date: 2001
  In 1999, the Rural Hospital Flexibility Program National Tracking Team made site visits to 12 states and 24 critical access hospitals (CAHs) in order to determine the extent of program implementation in the states and the approaches that states, hospitals and communities are taking in using the Flex Program to achieve improvements in rural health care.
• Scope of Services Offered by Critical Access Hospitals: Results of the 2004 National CAH Survey
  Author(s): David Hartley, Stephenie Loux
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Flex Monitoring Team Briefing Paper No. 5
  Date: 03 / 2005
  Three years of national survey data (2000, 2002, and 2004) were used to examine the scope of services offered by Critical Access Hospitals (CAHs). The authors investigated how the services offered by CAHs have changed, the role of network affiliations in these changes, and the reasons administrators gave for reported service expansions. Additionally, the authors looked at how services in CAHs have changed over time. Consistent with findings in previous surveys conducted by the Flex Team, conversion to CAH status has not led to downsizing of services. Most CAHs offer a core set of services including radiology, laboratory services, emergency rooms, swing beds, pharmacy, outpatient rehabilitation, outpatient surgery, and specialty clinics. While this core has not changed significantly over the period of three surveys, many CAHs have added or expanded services not dependent on inpatient capacity Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• State Flex Program at 10 Years: Strengthening Critical Access Hospitals and Rural Communities
  Author(s): John A. Gale, Jennifer Lenardson, Walter R. Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Policy Brief No. 3
  Date: 04 / 2007
  To understand the priorities and accomplishments of state Flex Grant Programs, members of the Flex Monitoring Team asked Flex Coordinators to identify and discuss their states’ three most successful initiatives in the past two years. Interviews were conducted during February 2007 with Flex Coordinators and State Office of Rural Health staff (SORH) in all 45 states. The listed publication is a policy brief; the full report will be available in the fall of 2007. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program
  Author(s): John Gale, Jennifer Lenardson, Walt Gregg, Michelle Casey, Indira Richardson, Stephen Rutledge, Rebecca Slifkin
  Research centers: Maine Rural Health Research Center, Minnesota Rural Health Research Center , North Carolina Rural Health Research and Policy Analysis Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Flex Monitoring Team Briefing Paper No. 15
  Date: 10 / 2007
  Explores activities funded by the Medicare Rural Hospital Flexibility Program (Flex Program) to strengthen the rural health care infrastructure and discusses which activities were considered most successful by State Flex Coordinators. Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Survey of Critical Access Hospital (CAH)-Affiliated Emergency Medical Service (EMS) Providers
  Research center: Walsh Center for Rural Health Analysis
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS)
  Date: 09 / 2003
  To provide a description of EMS providers in rural communities, particularly those with CAHs
• Synthesis of State Flex Program Plans 2003-2004
  Author(s): Rochelle Schultz Spinarski, Walter Gregg
  Research center: Minnesota Rural Health Research Center
  Topic: Critical Access Hospitals and Rural Hospital Flexibility Program
  Report Number: Briefing Paper No. 1
  Date: 05 / 2004
  Highlights recent trends in the development and implementation of State Flex Programs, whose goal it is to strengthen the rural healthcare infrastructure using CAHs as the hub of organized, local systems of care. A major portion of the FY2003 funding dollars continue to target state program infrastructure development; however, the role of this infrastructure is shifting from supporting conversions to the ongoing availability of appropriate health care services for communities served by CAHs (e.g., CAH performance improvement, EMS integration, systems development, and community engagement). States are pursuing these areas with a variety of strategies including the use of local, interstate, and regional collaborations to share lessons learned and advance their knowledge in key areas for success (e.g., performance and quality improvement, health information technology, and capital planning). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.
• Trends over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
  Author(s): Kathleen Dalton, Rebecca Slifkin, Jeongyoung Park, and Hilda Ann Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health services
  Report Number: Findings Brief No. 81
  Date: 02 / 2006
  Examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on Critical Access Hospitals (CAHs).
• Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
  Author(s): David Hartley, Erika C. Ziller, Stephenie L. Loux, John A. Gale, David Lambert, Anush E. Yousefian
  Research center: Maine Rural Health Research Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Emergency medical services (EMS), Mental health
  Citation: Journal of Rural Health, 23(2), 108-115
  Date: 2007
  Describes the results of a study investigating the use of critical access hospital (CAH) emergency rooms by patients with mental health problems to understand the role these facilities play in rural mental health needs and the challenges they face.
• Variations in Financial Performance Among Peer Groups of Critical Access Hospitals
  Author(s): George H. Pink, George M. Holmes, Roger E. Thompson, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing
  Citation: Journal of Rural Health, 23(4), 299–305
  Date: 2007
  Reports findings from a study that investigated whether indicators of financial performance and condition systematically vary among peer groups of Critical Access Hospitals (CAHs). Report produced by the Flex Monitoring Project, funded by the Office of Rural Health Policy.

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• Hospitals and clinics (73 items)