Beginning in 2004, the Flex Monitoring Team developed a set of twenty financial indicators, derived from data contained in Medicare cost reports, which captured six dimensions of financial performance: profitability, liquidity, capital structure, revenue, cost, and utilization. By 2017, three more indicators had been added in response to Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) user requests. However, since these initial indicators and benchmarks were developed, there have been significant changes in reimbursement and the rural hospital operating environment, which may necessitate new measures, revised benchmarks, or new reporting mechanisms. In this project, the Flex Monitoring Team will:

1. Assess the quality and usefulness of the established twenty-three indicators;
2. Determine whether there is a need to add or retire indicators to improve the ability to evaluate hospital financial performance;
3. Assess and revise current benchmarks or establish new benchmarks as determined by evidence.