Healthcare Insights

Critical Access Hospitals with the Highest Readmission Rates

Critical access hospitals (CAHs) provide essential care to populations that might not otherwise have healthcare access. To qualify as a critical access hospital, these facilities must be located in a rural area. In rural areas, population density is lower, and the number of uninsured or underinsured patients is generally higher.

Critical access hospitals treat many low-income patients with little to no insurance coverage. Because of this, complications and high readmission rates are much more likely.

Are critical access hospitals exempt from the readmission reduction program?

Critical access hospitals play an important role in improving care access. Because of this, they receive certain benefits from the Centers for Medicare and Medicaid Services (CMS). As part of these benefits, CAHs are exempt from financial penalties in the Hospital Readmissions Reduction Program (HRRP).

CMS instituted the Hospital Readmissions Reduction Program in 2012. The goal of this program is to reduce excess 30-day readmissions for the following six conditions:

The HRRP has a strong focus on reducing 30-day readmissions for cardiovascular conditions. Three of the six conditions listed above are related to heart conditions. Cardiac readmissions are particularly relevant for critical access hospitals. According to the National Institutes of Health, poverty can increase the risk of many diseases, including:

  • Heart disease
  • Diabetes
  • Cancer

Critical access hospitals may not face financial penalties from CMS for excess readmissions. But because of the increased risk factors that low-income patients face, many CAHs report high 30-day readmission rates.

Here are the top 25 critical access hospitals by all-cause hospital-wide readmission rate.

Top 25 critical access hospitals by all-cause hospital-wide readmission rate

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RankDefinitive IDHospital NameStateNumber of Staffed BedsTotal DischargesAll-Cause Readmission RateExplore This Dataset
11500Orange City Area Health SystemIA2581617.50%Explore This Profile
23792Macon County General HospitalTN2578317.50%Explore This Profile
35516Riverside Medical CenterLA2531917.30%Explore This Profile
42316Simpson General HospitalMS2530417.20%Explore This Profile
54608Hot Springs County Memorial HospitalWY2548917.10%Explore This Profile
63892Coleman County Medical CenterTX2549917.10%Explore This Profile
74249Gifford Medical CenterVT251,14817.10%Explore This Profile
83672Huron Regional Medical CenterSD251,29517.00%Explore This Profile
92538Avera St Anthonys HospitalNE2578217.00%Explore This Profile
10230Piggott Community HospitalAR2572917.00%Explore This Profile
111185Hardin County General HospitalIL2537916.90%Explore This Profile
123078Adams County Regional Medical CenterOH2592316.90%Explore This Profile
133260The Physicians Hospital In AnadarkoOK2517916.80%Explore This Profile
141510Wayne County HospitalIA2580416.80%Explore This Profile
151647Casey County HospitalKY2458616.80%Explore This Profile
161720The Medical Center at FranklinKY2553916.80%Explore This Profile
176180Fulton County HospitalAR2554916.80%Explore This Profile
181550Graham County HospitalKS2021216.70%Explore This Profile
192404Perry County Memorial HospitalMO251,50616.70%Explore This Profile
204087Medina Regional HospitalTX2554916.70%Explore This Profile
215532Fayette County HospitalIL2948916.70%Explore This Profile
224982Avera Gettysburg HospitalSD1010516.60%Explore This Profile
233878Memorial Medical CenterTX2584116.60%Explore This Profile
242353Cass Regional Medical CenterMO2582716.60%Explore This Profile
251517Allen County Regional HospitalKS2540916.60%Explore This Profile

Fig. 1 Data is from Definitive Healthcare’s Hospitals & IDNs database. All-cause hospital readmission rates are sourced from the July 2020 CMS Quality Metrics Update. The next Quality Metrics Update is scheduled to be released in October 2020. Accessed September 2020.

Which critical access hospitals have the highest all-cause readmission rates?

Orange City Area Health System and Macon County General Hospital have the highest all-cause readmission rates. As of July 2020, both these CAHs reported an all-cause readmission rate of 17.5 percent. According to Definitive Healthcare data, 15.59 percent is the average all-cause readmission rate at U.S. hospitals.

We might expect that hospitals with more total discharges report higher readmission rates. With each patient discharge, there is a risk for 30-day readmission. Interestingly, there does not seem to be a correlation between total discharges and readmission rate. For instance, some of the top 25 CAHs report more than 1,000 total discharges. Despite this, they have lower all-cause readmission rates than other hospitals on the list.

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