17 May Critical Access Rural Hospitals Provide Safe Care At Lower Costs
MedicalResearch.com Interview with:
Andrew M. Ibrahim, MD
Robert Wood Johnson Clinical Scholar (VA Scholar),
Institute for Healthcare Policy & Innovation, University of Michigan
Ann Arbor, MI
MedicalResearch.com: What is the background for this study?
Dr. Ibrahim: Critical access hospital designation was created to help ensure access to the more than 59 million people living in rural populations. Hospitals were eligible for critical access designation if they had less than 25 beds and were located more than 35 miles away from another hospital. With this designation they were paid above total cost for the care they provided. Previous reports suggest these centers provide lower quality of care for common medical admissions, however little was known about surgical conditions.
MedicalResearch.com: What are the main findings?
Dr. Ibrahim: This study included a review of 1,631,904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3,676) for 1 of 4 common types of surgical procedures: appendectomy, gall bladder removal, removal of all or part of the colon, and hernia repair. Patient who underwent surgery at critical access hospitals were, on average, less medically complex.
Compared to larger urban hospitals, these small rural hospitals (i.e. critical access hospitals) had the same 30-day mortality rates and lower complications rates. In addition, critical access hospitals costs on average $1400 less per patient to Medicare, despite being paid in an alternative payment system. These findings remained significant after accounting for the patient’s pre-operation health condition.
MedicalResearch.com: What should readers take away from your report?
Dr. Ibrahim: For the common surgical operations we studied, critical access hospitals provide safe surgical care at lower costs. These findings are consistent with rural surgeons appropriately triaging more complex patients to larger centers, while providing less complex patients safe surgical care in their community.
As more than 600 rural hospitals are at risk of closing, this study provides important information about their unique role in our medical system.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Ibrahim: As our healthcare system develops new payment models and places resources to improve quality of care, more research about how these small rural hospitals are able to provide high quality, low-cost care for common operations may have lessons for everyone else.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation: JAMA
Andrew M. Ibrahim, Tyler G. Hughes, Jyothi R. Thumma, Justin B. Dimick. Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries. JAMA, 2016; 315 (19): 2095 DOI: 10.1001/jama.2016.5618
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on May 17, 2016 by Marie Benz MD FAAD