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.