Critical access hospitals are facilities designed to serve the needs of rural communities by providing 24-hour emergency services and both inpatient and outpatient services in areas where it might not be cost effective to do so. These small facilities receive special treatment in the Medicare program and are exempt certain reporting requirements. While death rates in larger hospitals dropped from 2002 to 2010, the death rates at these small rural hospitals increased. The increase calls into question whether the special treatment for these small hospitals is having a detrimental effect on the patients they serve by promoting medical mistakes.
The author of the study that revealed the deteriorating performance of critical access hospitals suggested that the facilities were "falling further and further behind." The reason could be the differing standards used for these hospitals. First, Medicare has requirements concerning efficiency in treating patients. Those requirements are waived for critical access hospitals. Second, most hospitals are required to report how Medicare patients fare from their treatment. The CAH facilities to not have to report the results of the Medicare services they provide. A recent push to force hospitals to make their performance more easily accessible to the public may have little impact on rural facilities. Patients in these areas may not have a realistic choice in obtaining medical care. Even a facility with a poor track record could get a pass from patients who would have to drive more than an hour to get to another hospital.
Another problem is that, despite the increased Medicare payments, rural hospitals may not be able to afford equipment or access to specialists that help larger hospitals reduce their death rates. Whatever the reason, it is alarming that more patients are dying in these hospitals now than 10 years ago.
Source: Minneapolis Star Tribune, "Study says death rates worse at rural hospitals," 7 April 2013