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By Taylor Sisk

On the heels of a report warning that more than a third of the nation’s critical access hospitals are in danger of closure comes some encouraging news. A new study indicates certain procedures are being performed in these small hospitals more safely and at a lower cost than in larger institutions.

A University of Michigan team of researchers looked at four common surgeries – appendectomy, gall bladder removal, hernia repair and removal of all or part of the colon – and found no statistically significant difference in 30-day mortality rates between critical access and other hospitals.

Further, critical access hospitals experienced serious complications in performing these procedures 6.4 percent of the time as compared with 13.9 percent of the time in other hospitals.

CAHs also billed Medicare an average of $1,400 less for the procedures.

CAHs serve many of the nation’s remotest regions. By definition, they have fewer than 25 beds and are more than 35 miles from the next nearest hospital. They must maintain an average length of stay of 96 hours or less for acute-care patients and provide 24-hour emergency-care services. In return, they receive preferential reimbursement from Medicare, which covers more of their costs.

North Carolina had 20 critical access hospitals as of Nov. 2014. Since that time, Yadkin Valley Community Hospital has closed. Blue areas on the map indicate non-metropolitan counties. Map courtesy UNC Sheps Center for Health Services Research

There are 1,284 CAHs throughout the country; North Carolina has 20.

Two CAHs in the state have shut down in just over two years: Vidant Pungo Hospital in Belhaven in February 2014 and Yadkin Valley Community Hospital in Yadkinville in May of last year.

Doing what they should

The Michigan researchers examined more than 1.6 million Medicare-beneficiary admissions to 828 CAHs and 3,676 other hospitals. Their results were published last week in the Journal of the American Medical Association.

Transylvania Regional Hospital. Photo credit: John Warner

The researchers found that patients who had any of the four types of operations at CAHS tended to be healthier upon admission than patients treated for the same procedures at other hospitals. They said this indicated CAH surgeons appropriately selected patients who they felt would be most likely to have positive outcomes, while sending higher-risk patients to larger hospitals.

“From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care,” lead author Andrew Ibrahim said in a release.

That said, even after correcting for differences in health status at the time of the operations, the CAHs had equal or better outcomes.

‘On the firing line’

In rural communities throughout the country, small hospitals in general, and critical access hospitals in particular, are facing mounting challenges including reduced reimbursements; aging, declining populations; and difficulties recruiting health care professionals.

“Critical access hospitals are on the firing line. They’re in the middle of the target,” Alvin Hoover, past chairman of the American Hospital Association’s Small or Rural Governing Council and current board chair of the Mississippi Hospital Association, said in a recent interview. “It’s hard for me to understand why you want to target those guys, because if you look at the cost of care, they do it cheaper than anybody else.

“If you can keep that person home, right there in that local community, your cost of treatment of that pneumonia patient, [for example], is going to be way less than it is if you have to send them to the big university.”

The outcomes found in this research, the study’s authors write, should “inform legislators about the valuable role critical access hospitals provide in the U.S. health care system.”

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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Taylor Sisk

Taylor Sisk is a writer, editor, researcher, producer and documentary filmmaker who served as the rural health reporter from 2015 into 2016. He has served as a managing and contributing editor of The Carrboro...