Critical access hospitals have higher transfer rates after surgery

May 14, 2014

Hospital transfers happened more often after surgery at critical access hospitals (CAHs) but the proportion of patients using post-acute care was equal to or less than that of patients treated at non-CAHs.

The CAH designation was created to provide financial support to rural hospitals. As such, they are exempt from Medicare's Prospective Payment System and instead are paid cost-based reimbursement. The proliferation of CAHs after the payment policy change has increased interest in the quality and cost of care these facilities provide.

The authors used data from the Nationwide Inpatient Sample and the American Hospital Association to examine undergoing six common surgical procedures (hip and knee replacement, hip fracture repair, colorectal cancer resection, gall bladder removal and transurethral resection of the prostate [TURP]) at CAHs or non-CAHs. The authors measured hospital transfer, discharge with post-acute care or routine discharge. The authors identified 4,895 acute-care hospitals reporting from 2005 through 2009: 1,283 (26.2 percent) of which had a CAH designation.

For each of the six inpatient surgical procedures, a greater proportion of patients from CAHs were transferred to another hospital (after adjustment for patient and hospital factors), ranging from 0.8 percent for TURP to 4.1 percent for hip fracture repair for CAH patients and from with 0.2 percent and 1.2 percent for the same procedures, respectively, for non-CAH patients. However, patients discharged from CAHs were less likely to receive post-acute care for all but one of the procedures (TURP) examined. The likelihood of receiving post-acute care ranged from 7.9 percent for gall bladder removal to 81.2 percent for repair for CAH patients and from 10.4 percent to 84.9 percent, respectively, for non-CAH patients. The authors note there must be future work to define the causes for the disparity in transfer rates.

"These results will affect the ongoing deliberations concerning CAH payment policy and its implications for health care delivery in rural communities" Adam J. Gadzinski, M.D., M.S., of the University of Michigan Health System, Ann Arbor, Mich., and colleagues said in their JAMA Surgery article.

In a related commentary, Matthew J. Resnick, M.D., and Daniel A. Barocas, M.D., M.P.H., of Vanderbilt University, Nashville, Tenn., write: "The article by Gadzinski and colleagues raises important questions about how best to maintain access to surgical care in underserved communities."

"There remains no obvious mechanism to ensure the financial viability of individual CAHs, particularly in the era of the integrated system. Medicare will probably have to continue subsidizing these hospitals to maintain broad access to financially unsuccessful service lines; the challenge will be to keep the quality and cost corners of the triangle from growing too obtuse or acute."

Explore further: In-hospital mortality no different at critical access hospitals

More information: JAMA Surgery. Published online May 14, 2014. DOI: 10.1001/jamasurg.2013.5694
JAMA Surgery. Published online May 14, 2014. DOI: 10.1001/jamasurg.2013.5707

Related Stories

In-hospital mortality no different at critical access hospitals

May 5, 2013
(HealthDay)—For eight inpatient surgical procedures, mortality is similar at critical access hospitals (CAHs) and non-CAHs, but costs are higher at CAHs, according to a study published online May 1 in JAMA Surgery.

Mortality rates have increased at hospitals in rural communities for certain conditions

April 2, 2013
In an analysis that included data on more than 10 million Medicare beneficiaries admitted to acute care hospitals with a heart attack, congestive heart failure, or pneumonia between 2002 and 2010, 30-day mortality rates for ...

Patients at small, isolated, rural hospitals in US more likely to receive lower quality of care

July 5, 2011
In the first national study to examine care at critical access hospitals (CAHs) in rural areas of the U.S., Harvard School of Public Health (HSPH) researchers found that CAHs have fewer clinical capabilities, lower quality ...

Hospital readmission rate varies following care at rehabilitation facility

February 11, 2014
Among rehabilitation facilities providing services to Medicare fee-for-service patients, 30-day hospital readmission rates vary, from about 6 percent for patients with lower extremity joint replacement to nearly 20 percent ...

Surgery study shows worse health, more problems and higher costs among Medicaid patients

May 12, 2014
Surgery patients covered by Medicaid come into their operations with worse health, do worse afterward, stay in the hospital longer and find themselves back in the hospital more often than those covered by private insurance, ...

Black surgery patients in US more likely to receive unnecessary, and dangerous, blood transfusions

May 9, 2014
Black patients in the U.S. are more likely to receive perioperative red blood cell (RBC) transfusions for two of three frequently performed surgical procedures, posing a risk for favorable outcomes, a study by University ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.