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
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.
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.