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May 23, 2016

For these 4 procedures, critical access hospitals may do best, study suggests

Daily Briefing

Critical access hospitals (CAHs) may provide lower-cost higher-quality care for several common surgical procedures, according to a new study published in JAMA.

CAHs are those that have fewer than 25 inpatient beds and are located more than 35 miles from any other hospital. They primarily treat rural patients and receive slightly higher reimbursements from Medicare in an effort to improve access to care in underserved areas.

CAHs have also come under scrutiny for their outcomes, as some research indicates they produce higher mortality rates for certain inpatient surgeries.

Study details

But a new study in JAMA suggests that—at least for certain procedures—CAHs may be cheaper and safer than larger, non-CAH hospitals.

For the study, researchers from the University of Michigan examined 1.6 million Medicare admissions to 828 CAHs and 3,676 non-CAHs between 2009 and 2013. The study examined 30-day mortality rates, costs, and serious complication rates for four common surgical procedures:

  • Appendectomy;
  • Gallbladder removal;
  • Removal of all or part of the colon; and
  • Hernia repair.

The researchers controlled for factors including age, health status, and whether the surgery was elective, urgent, or emergency.

Across the four procedures, the study found no statistically significant difference in 30-day mortality rates between CAHs and non-CAHs. But CAHs outperformed in their rate of serious complications (6.4 percent) compared with non-CAHs (13.9 percent). Surgeries at CAHs also cost Medicare an average of $1,395 less after adjusting for patient factors, according to the study.

More critical-access hospitals close their doors


The researchers hypothesize that CAHs may have had better outcomes in part because their patients were healthier and their surgeries less complex than at non-CAHs. "From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care," says study co-author Andrew Ibrahim.

Study co-author Tyler Hughes, a director of the American Board of Surgery, adds, "This study gives credence to what rural surgeons long suspected—that well-done rural surgery is safe and cost-effective" (Punke, Becker's Infection Control & Clinical Quality, 5/17; Budryk, FierceHealthcare, 5/18; UPI/Health Day News, 5/17; Ibrahim et al., JAMA, 5/17).

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