Rural Hospitals and Surgical Outcomes

Critical access hospitals in the Medicare program receive that designation if they have less than 25 beds and are more than 35 miles from another hospital.  These hospitals get special reimbursement to ensure their viability in providing care access for rural residents.  Research in the Journal of the American Medical Association examines surgical outcomes at these critical access hospitals.   (JAMA Article)  The researchers used data from 2009 to 2013 for roughly 1300 critical access facilities, focusing on appendectomy, cholecystectomy, colectomy, and hernia repair, the most common procedures at these hospitals.  Mortality, complications, re-operations and readmissions were compared with those at non-critical access institutions, as well as price to Medicare and price-standardized payments.  In general, patients at the critical access hospitals were likely to be less ill.  Emergency operations were more common at these facilities.  These hospitals were obviously smaller and did fewer surgeries than the average non-critical access facility.

On a risk-adjusted basis, the critical access hospitals had either the same or better clinical outcomes, with lower rates of in-hospital mortality and the same rates of 30-day mortality.  They had lower rates of serious and overall complications.  They did have higher rates of readmission.  Actual Medicare payments across all the surgeries averaged $5980 less at critical access hospitals than at non-critical ones.  Even after risk-adjustment and price standardization, the Medicare payment difference was $1395.  Overall the results suggest that critical access hospitals are providing good quality at a lower cost to Medicare.  It also suggests that the physicians working at these hospitals may be doing a good job of referring more complex patients to larger facilities with the resources to handle their care better.  Both implications are good for the rural residents who depend on these hospitals for a significant portion of their health care needs.