A Critical Access Hospital Update, September 2002
As of August 1, 2002, there were 657 certified Critical Access Hospitals (CAHS) and numerous others involved in the Medicare Rural Hospital Flexibility Grant Program (Flex Program).
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Certified CAHs: The number of hospitals that have been certified as CAHs by the Centers for Medicare and Medicaid Services (CMS).
- Governor-Designated CAHs: The number of hospitals that qualify for the CAH Program through Governor-designated authority as opposed to the standard federal statutory mileage and location requirements. Examples of these types of designations are those that have been designated by a state as "Necessary Providers."
- CAH Certifications Pending: The number of hospitals currently awaiting CAH designation and/or certification.
- Hospitals Actively Considering Conversion: The number of hospitals likely to consider conversion.
- Hospitals Eligible for Conversion: The number of non-CAHs that meet state CAH eligibility criteria, but have not become actively involved with the Flex Program.
- FLEX-Assisted Hospitals: The total number of hospitals that have received state-brokered technical and financial assistance to prepare them for Flex Program participation (e.g., assessments, education, advice, and funding to purchase assistance or invest in operational preparations to facilitate program-related goals).
Data Collection
The Flex Program Tracking Team has been monitoring the number of CAH conversions since nearly the beginning of the program. This tracking process has evolved over the past four years and now provides not only an accurate and reliable method of data collection but a rich context for exploring hospital participation in the program. Data for the report were collected from CMS and the state offices responsible for implementation of the Flex Program. These data have also been linked to secondary sources to provide community-level characteristics of CAHs. In July 2002, all state Flex Program Coordinators were contacted and asked to provide the number of facilities that fell into the categories reported in Table 1.
Where are the CAHs
Map 1 depicts the location of all 657 CAHs, as well as six CAHs that have since closed. The majority of converting hospitals, as is readily apparent from the map, are located in the Midwest. The smaller concentration of CAHs in the Northeast region of the country reflects the impact of a greater number of urban areas. The lower ratio of nonmetropolitan compared to metropolitan areas significantly reduces the pool of eligible hospitals for conversion.
Map 1
The Balanced Budget Refinement Act of 1999 (BBRA) permitted hospitals located in metropolitan statistical areas that resembled rural facilities to participate in the program; it was referred to as a reclassification of certain urban hospitals as rural hospitals. Hence, 59 CAHs are located in metropolitan counties (Map 2). Although these facilities are located in a defined urban area, they are typically located on the border of a rural, sparsely populated area in a metropolitan county.
Map 3 depicts the 173 CAHs that are located in frontier counties, defined here as having no more than seven persons per square mile. Except for one facility in Maine, the remaining hospitals are located in the Midwest and West. The distribution of frontier hospitals along the Canadian border is also quite marked. Compared to the U.S. population, the individuals living in the communities with operating CAHs are older, poorer, more likely to be unemployed, and less diverse in ethnic composition (Table 2).
1Technical Assistance Services Center, 2002. H.R. 3426. Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999. Rural Health Resource Center
Map 2
Map 3
Where Can I Get More Information?
About this report: Melissa A. Fruhbeis, MSPH, North Carolina Rural Health Research & Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, UNC-CH, (919) 966-9985 or [email protected]
About this Project: Check out their website Rural Policy Research Institute
Previous Findings From The Field and Tracking Project Reports
Report: Rural Hospital Flexibility Program Tracking Project Year Three
Vol. 2, No. 5: Reauthorizing the Medicare Rural Hospital Flexibility Grant Program: Lessons from the Field
Vol. 2, No. 4: Critical Access Hospitals and Community Development
Vol. 2, No. 3: Administration in Critical Access Hospitals
Vol. 2, No. 2: Regionalization of Emergency Medical Services: The Experience of Michigan's Upper Peninsula
Vol. 2, No. 1: Impact of the Rural Hospital Flexibility Program on Rural Emergency Medical Services: Evidence From the First Two Years
CAH/FLEX - National Tracking Project
FINDINGS FROM THE FIELD
Volume 2, Number 6, September 27, 2002
Consortium Members
Project HOPE Walsh Center for Rural Health Analysis
Rural Policy Research Institute
University of Minnesota Rural Health Research Center
University of North Carolina Rural Health Research and Policy Analysis Program
University of Southern Maine Rural Health Research Center
WWAMI Rural Health Research Center
