Community Impact and Benefit Activities of CAHs, Other Rural, and Urban Hospitals, 2014

Non-profit hospitals, including Critical Access Hospitals (CAHs), are required to report their community benefit activities (programs and services that provide treatment and/or promote health in response to identified community needs) to the Internal Revenue Service. Using a set of community benefit indicators developed by the Flex Monitoring Team (FMT), these reports compare CAHs to non-metropolitan non-CAHs (non-metro hospitals) and metropolitan (metro) hospitals in order to monitor the community benefit activities of CAHs and understand whether and how their community benefit profiles differ from the profiles of other hospitals. The Flex Monitoring Team also produces state-specific reports with more detailed results

Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2017

Non-profit and publicly-owned hospitals, including Critical Access Hospitals (CAHs), have obligations to address the health needs of their communities. Non-profit hospitals are required to report their community benefit activities to the Internal Revenue Service using Form 990, Schedule H. Community benefit activities include programs and services that provide treatment and/or promote health in response to identified community needs. Publicly-owned hospitals are also held accountable to the needs of their communities through the oversight of their governing boards and local governments. To monitor the community impact and benefit activities of CAHs and to understand whether and how their community impact and benefit profiles differ from those of other hospitals, we compared CAHs to other rural and urban hospitals using a set of indicators developed by the FMT. This report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally (Tables 1 and 2) to the performance of CAHs in their state (see links to state-specific tables on page 5). Table 1 provides data for select measures of community impact and benefit, including the provision of essential health care services that are typically difficult to access in rural communities. Table 2 provides data on hospital charity care, bad debt, and uncompensated care activities. The Flex Monitoring Team also produces state-specific reports with more detailed results

Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Briefing Paper #32)

Variations in reimbursement policies and swing bed use suggest that the incentives influencing the decisions of CAHs regarding their Skilled Nursing Facility (SNF) units may differ from those of urban hospitals. Based on a review of the literature and conversations with members of the Flex Monitoring Team’s Expert Work Group, we expected the financial decision regarding SNF unit operation to be more complex for CAHs than for PPS hospitals largely because the decision involves the profitability of a PPS-reimbursed SNF within a cost-based facility. In the case of the CAH, the indirect and facility costs associated with operating a PPS-reimbursed SNF unit must be subtracted from the cost base of the cost-reimbursed acute care services thereby reducing reimbursement for those services. We also expected that the availability of swing beds (which can be used effectively to manage acute care length of stay issues without compromising acute care reimbursement) would be a significant factor in decisions to close SNF units. We identified other factors that might influence a CAH’s decision to retain a SNF unit including: the need for an alternative to swing beds to manage length of stay issues for CAHs with consistently high acute care census levels; community need and preference (which might be particularly important for municipal and county-owned hospitals); and limitations on SNF unit closure imposed by state Certificate of Need regulations. Among the potential factors influencing a CAH’s decision to close or retains its SNF units, only the latter factor (i.e., the influence of Certificate of Need regulations) was not supported by our study. We interviewed 20 CAHs operating in eleven states, including 11 hospitals that had closed their SNF units and 9 that continued to operate their services. This report discusses our findings in detail; there is also a policy brief which highlights the same findings

Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Briefing Paper #30)

The Institute of Medicine has emphasized the importance of establishing a culture of safety to improve patient care, specifically: developing clear, highly visible patient safety programs that focus organizational attention on safety; using non-punitive systems for reporting and analyzing errors; incorporating well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establishing proven interdisciplinary team training programs for providers. We sought to investigate the degree to which these elements are present or absent in Critical Access Hospitals. This report presents the results of a literature review and a rural patient safety expert panel comprised of representatives from federal and state government and academia. There is another policy brief that summarizes these same findings

An Inventory of State Flex Program Population Health Initiatives for Fiscal Years 2019-2023

This brief responds to interest from State Flex Programs (SFPs) and other Critical Access Hospital (CAH) stakeholders about the range of population health initiatives proposed and implemented across the Flex Program by summarizing the population health initiatives proposed by each of the 45 SFPs. The authors identify the output/process and outcome measures described by the SFPs in their applications and program materials, as well as the organizations serving as their partners in this work. This brief serves as a companion to our initial brief, Evaluating State Flex Program Population Health Activities, which provides a high-level overview of SFP population health activity, highlights promising population health strategies, reviews issues related to monitoring the outcome of SFP population health activities, and explores opportunities to align SFP population health activities with the Health Resources and Services Administration’s Healthy Rural Hometown Initiative To view the Evaluation brief: https://www.flexmonitoring.org/sites/flexmonitoring.umn.edu/files/media/EvaluatingSFPPopHealthActivities.pd

Community Benefit Activities of CAHs, Non-Metropolitan Hospitals, and Metropolitan Hospitals, 2010

Non-profit hospitals, including Critical Access Hospitals (CAHs), are required to report their community benefit activities (programs and services that provide treatment and/or promote health in response to identified community needs) to the Internal Revenue Service. Using a set of community benefit indicators developed by the Flex Monitoring Team (FMT), these reports compare CAHs to non-metropolitan non-CAHs (non-metro hospitals) and metropolitan (metro) hospitals in order to monitor the community benefit activities of CAHs and understand whether and how their community benefit profiles differ from the profiles of other hospitals. The Flex Monitoring Team also produces state-specific reports with more detailed results

Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Policy Brief #31)

This policy brief addresses the factors related to closure of skilled nursing units by some Critical Access Hospitals (CAHs) and the continued provision of these services by others. Key Findings Critical Access Hospitals(CAHs) that closed Skilled Nursing Facility (SNF) units cited a range of financial challenges related to payer mix, operating costs, cost allocation methods, and service utilization patterns. The availability of alternative local long term care services, including swing beds, often contributed to hospitals’ decisions to close their SNF units. CAHs that continued to operate SNF units were driven primarily by community need, despite the financial disincentive for doing so. Hospitals reported substantial variation in their strategies for using swing beds for SNF, rehabilitation, and post-acute services. Given ongoing concerns about financial viability and low census rates among some CAHs, further research on the ability of CAHs to expand patient services and revenues through swing bed use is warranted. Additional research on the quality and outcomes of skilled care delivered by CAHs in SNF and swing beds is also recommended

CAH-Relevant Measures for Health System Development & Population Health (Policy Brief #42)

This policy brief describes the development of the health systems development and population health performance measures that will be included in the Flex Monitoring Team’s forthcoming integrated performance reporting system. In addition to reviewing the individual measures that comprise the measures set, we discuss how the measures can help stakeholders benchmark and improve performance by targeting technical assistance and support to CAHs and rural communities. Researchers at the University of Southern Maine\u27s Flex Monitoring team enlisted the advice of a national panel of community benefit, community health improvement, population health, and rural health experts to assist with the development of a set of health systems development and population health measures relevant to the CAH and rural community context. The resulting measures set contains three subcategories of measures, each with a different focus and intended use: (1) charity care and bad debt; (2) community health improvement, essential community health services, and community benefit; and (3) community health needs and issues

Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Policy Brief #27)

The Institute of Medicine has emphasized the importance of establishing a culture of safety to improve patient care, specifically: developing clear, highly visible patient safety programs that focus organizational attention on safety; using non-punitive systems for reporting and analyzing errors; incorporating well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establishing proven interdisciplinary team training programs for providers. We sought to investigate the degree to which these elements are present or absent in Critical Access Hospitals. This brief presents the results of a literature review and a rural patient safety expert panel comprised of representatives from federal and state government and academia. Key Findings: Establishing a culture of patient safety includes promoting a nonpunitive environment of shared accountablity (a just culture), encouragement to report errors (a reporting culture), and development of a learning culture. Research demonstrates a positive relationship between organizational culture and safety outcomes for both patients and employees. Use of the AHRQ Hospital Survey on Patient Safety Culture has been effective for planning, implementing, and evaluating targeted patient safety interventions in CAHs