Health System Challenges for Critical Access Hospitals: Findings From a National Survey of CAH Executives


Despite the numerous challenges of operating a Critical Access Hospital (CAH), there is little research examining the perspectives of CAH executives on potential community healthcare options if the CAH were to close. This brief presents a subset of results from a national survey of CAH executive perspectives on pressing challenges.

This brief presents the responses of 174 CAH executives (13%) on healthcare challenges they face leading a CAH. Three of the major challenges identified were uncompensated care and affordability of health insurance; patient and ambulance bypass that reduces hospital reimbursement and influences patient perceptions of quality, and; uncertainty about the 340B program because access to medications and medication services has declined in many rural areas. Medicaid disproportionate share hospital payments, Medicaid expansion, survival of the Patient Protection and Affordability Act, and potential reductions to private, state, and federal revenue sources were identified as other health system challenges that will affect CAHs.

In conclusion, the health system challenges identified in this survey are many, substantial, and long-standing. It is likely that these challenges will increase because of COVID-19, further jeopardizing the ability of CAHs to meet the needs of their community and threatening the long-term viability of many rural hospitals.

North Carolina Rural Health Research and Policy Analysis Center
Sharita Thomas, Kristie Thompson, Kathleen Knocke, George Pink