In the News
Care quality at critical access hospitals (CAHs). CAHs provide inpatient care to underserved—primarily rural—areas. Consequently, they receive larger Medicare reimbursements and are exempt from quality improvement requirements. Two recent studies sought to determine whether care quality has suffered as a result of that exemption, as well as other factors such as older, poorer patient populations and limited resources. The first, published in the April 3 JAMA, found that mortality among Medicare patients with acute myocardial infarction, congestive heart failure, and pneumonia was higher at rural CAHs than at non-CAHs. Until 2002 the rates were similar but rose by 1.8% annually at CAHs through 2010. The second study, published online May 1 in JAMA Surgery, shows no difference in mortality following eight common types of surgery at CAHs and non-CAHs. However, surgery costs more at CAHs, ranging from $679 more for cesarean sections to $5,170 more for colorectal cancer resections.