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Services Provided at Critical Access Hospitals in 2011


The Critical Access Hospital (CAH) certification was created to ensure that rural beneficiaries are able to access hospital services. For most services provided, Medicare reimburses CAHs at 101 percent of their costs rather than at the rates set by the prospective payment systems or fee schedules. In 2011, Medicare and beneficiaries paid approximately $8.5 billion for services provided at CAHs.

CAHs are required to provide broad classes of services, including inpatient and outpatient services, but have latitude in what specific types of services they provide. They can also provide optional services such as "swing bed" services, which are the equivalent of skilled nursing services.

The purpose of this report is to aid policymakers and regulators as they consider the future role of CAHs in the delivery of hospital services. OIG has recommended that policymakers reevaluate which facilities are certified as CAHs. In addition, the Administration has proposed to decertify some CAHs and change how remaining CAHs are paid.


We analyzed 2011 enrollment data; inpatient and outpatient claims data; and cost report data to determine what types of services CAHs provided and the extent to which Medicare and other patients utilize these services. To provide perspective, we compared services and service utilization at CAHs to that within acute care hospitals, broken out by hospital size.


In 2011, CAHs provided outpatient services and, to a lesser extent, inpatient services to approximately 5 percent of all Medicare beneficiaries. At CAHs, more than eight times as many Medicare beneficiaries visited outpatient departments as visited inpatient departments. Compared to beneficiaries who received care at acute-care hospitals, a slightly higher percentage of beneficiaries who received services at CAHs received outpatient services. The outpatient services provided by CAHs were from a wide array of hospital departments. Laboratory services were the most commonly provided outpatient service at both CAHs and acute care hospitals.

CAHs' inpatient beds, which are limited to a maximum of 25 at each CAH, were not heavily utilized. In 2011, patients used approximately one of every five available CAH inpatient beds. When Medicare beneficiaries did receive inpatient services at CAHs, the services provided did not often include operating room procedures. In addition, more CAHs used their inpatient beds for swing bed services (i.e., services that beneficiaries would receive in a skilled nursing facility, such as nursing care and rehabilitative therapies) than did all acute-care hospitals. On average, CAHs used 10 percent of their available inpatient beds to provide swing bed services, while acute care hospitals used 4 percent of their available inpatient beds.