CAH - A Crisis in Rural America

The vast majority of critical access hospitals (CAH)were built under the Hill Burton Act from the late forties to the early seventies. Forty years since the last Hill Burton hospital was constructed, a high percentage of these facilities are out-of-date with no “curb appeal” and they lack the necessary capital formation to replace their existing hospital. The direct result of outdated rural hospitals is an inability to recruit physicians and attract patients— especially younger patients.

CAH administrators and CEOs have perhaps the toughest job in the industry; they are required to manage multiple departments within the hospital, maintain a quality staff, recruit physicians, meet payroll, pay vendors, add new services and continue to be competitive while operating in an outdated facility without sufficient capital and less than adequate cash flow.

The Board of Trustees has the responsibility of providing strategic oversight and to assure the community that they have access to quality healthcare services, not only in the present but also for the generations to follow. The Board of Trustees, like the CEO, are asked to accomplish this under difficult circumstances. In the case of public entities, county commissioners and city council members often go to the taxpayers for money to subsidize the hospital at a time when everyone feels they are already paying too much in taxes.