Critical Access Hospital Swing-Bed Quality Measures: Findings From Key Informant Interviews


Swing-beds are an important source of post-acute care for many patients residing in rural communities. Approximately 1,182 Critical Access Hospitals (CAHs) (88%) nationally provide swing-bed services. Medicare requires rural hospitals that receive reimbursement through the Prospective Payment System (PPS) to report data on their swing-bed patients through the Minimum Data Set (MDS), but does not require CAHs to collect similar information.

CAH swing-beds also have not been included in recent national quality measurement initiatives. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) requires post-acute providers—including Long-Term Care Hospitals, Skilled Nursing Facilities (SNFs), Home Health Agencies, and Inpatient Rehabilitation Facilities—to submit standardized and interoperable patient assessment data that will facilitate coordinated care, improved outcomes, and overall quality comparisons, but does not include CAH swing-beds.

We identified CAH networks and hospitals and conducted 20 key informant interviews to discuss efforts to assess CAH swing-bed quality of care, including measures being used or considered by CAHs, data collection strategies, and usefulness of measures. The key informant interview data were summarized and analyzed to identify common themes, including CAHs' motivations to assess swing-bed quality and challenges measuring CAH swing-bed outcomes.

University of Minnesota Rural Health Research Center
Michelle Casey, Ira Moscovice, Henry Stabler