Critical access hospitals (CAHs) are medical providers located in America’s most isolated regions, serving rural communities that do not otherwise have easily-available access to care. Since the closest alternatives to these hospitals are usually over 35 miles away, they provide an essential resource for Americans living in secluded communities — and therefore receive enhanced funding from the federal government to carry out their work. But according to a Harvard School of Public Health study, death rates at these hospitals are significantly higher than national averages — and are on the rise.
The study found that, while mortality rates in the nation’s other hospitals declined by 0.2 percent per year between 2002 and 2010, “critical access hospital death rates rose about 0.1 percent each year, reaching 13.3 percent in 2010.” Those numbers were also worse than non-CAH rural hospitals, leading head author Dr. Karen Joynt to suggest that a dearth of sophisticated medical technology and the special government treatment that CAHs receive may be contributing to higher death rates:
Joynt and her co-authors, John Orav and Dr. Ashish Jha, also of Harvard, suggested that the hospitals’ care may suffer because they don’t have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations. A previous paper by the trio found that critical access hospitals were less likely to have the ability to perform cardiac catheterizations and to have intensive care units. [...]
She also suggested that the hospitals may have been victims of their lenient treatment by the government. Since hospital officials are not required to evaluate their performances to make reports to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients.
“This is 1,000 hospitals, a quarter of the hospitals in the country, that are invisible,” she said. “We’ve created a completely separate system, and in this case it looks like that has not done patients in these hospitals any favors.”
Brock Slabach, an executive at the National Rural Health Association, cautioned against drawing sweeping conclusions from the report. “Mortality is just one small part of the picture of what qualities means,” he said. He said the association’s own research has found that rural hospitals do better in patient satisfaction surveys than do urban hospitals, and that there’s no substantial difference in other measures such as readmissions.
Slabach’s point is important to note — mortality shouldn’t be the only measure of a hospital’s or government program’s effectiveness, particularly for specialized populations in rural areas that have more specified needs than their urban counterparts. Americans living in rural areas have much higher numbers of elderly Americans than urban regions, meaning that mortality rates for rural areas will be skewed upwards to begin with. Furthermore, these populations have more children and are more likely to be poor, uninsured, under-insured, and chronically ill, meaning that preventative and ongoing primary care may ultimately be more important to the locales than more sophisticated secondary or tertiary care.
Still, the study’s findings draw attention to the reality that specialists are hard to come by in these areas. The vast majority of doctors in general — and specialists in particular — are concentrated in cities. But that doesn’t explain why non-CAH rural hospitals are apparently outperforming CAHs. And that suggests there may be something to the study authors’ point about lax reporting standards, which could be leading to a lack of nuance in the way that funding and resources are deployed to these providers.