Top 10 critical access hospitals by total operating expenses

Which critical access hospital had the highest total operating expenses? 

The data shows Mercyhealth Hospital and Medical Center – Walworth in Wisconsin tops the list with the highest total operating expenses of $558,687,367. This hospital alone accounts for about 24% of the total operating expenses across the top 10 CAHs.  

Coming in second is Coryell Memorial Healthcare System in Texas with $339,396,955 in operating expenses, and in third is Hu Hu Kam Memorial Hospital in Arizona with $245,491,765. The top 10 CAHs account for more than $2.3 billion in operating expenses, with an average of $235,901,959. 

What is a critical access hospital?  

A critical access hospital is a medical center offering medical services to rural areas. These communities are often underserved with higher populations of uninsured and underinsured individuals. CAHs are integral to providing access to healthcare to these populations.  

CAHs usually have increased staffing flexibility compared to other hospitals. For example, CAHs only need to have one physician (MD or DO). The physician does not need to be onsite and can instead be on-call, with the ability to be on-site within an hour. 

What services do critical access hospitals provide? 

CAHs typically offer 24/7 emergency care, have an average acute care inpatient length of stay of 96 hours or less each year and at most 25 inpatient beds. CAHs can utilize these beds as swing beds, which are beds that can be operated for either acute or post-acute care.   

Centers for Medicare and Medicaid Services (CMS) also sets forth critical access hospital regulations, requiring that CAHs: 

• Be located in a rural area 
• Be designated as a CAH by the state 
• Be located more than 35 miles from another hospital  
• Be located in a state that has an established Medicare Rural Hospital Flexibility Program  

What is the Medicare Rural Hospital Flexibility program? 

The Medical Rural Hospital Flexibility program is a federal program that increases access to quality healthcare in rural areas by helping CAHs, clinics, EMS and other health professionals work together. The flex program also provides funding for states to offer technical assistance to CAHs. 

How many critical access hospitals are there? 

According to the Definitive Healthcare HospitalView database, there are more than 1,400 critical access hospitals in the U.S. currently. This number is just around 15% of the total hospitals that Definitive Healthcare tracks.  

What are total operating expenses?  

Total operating expenses are a metric that is directly reported within the Medicare Cost Report (MCR). It reflects all the costs that hospitals use to run effectively.  

The MCR calculates total operating expenses with the following formula:  

Total operating expenses = operating expenses (salary + other costs) + total additions – total deductions  

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