This report examines the second year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures. The report updates previous national reports on Hospital Compare results for CAHs. There is also a policy brief profiling these same Year 2 findings.

The Flex Monitoring Team also produces state-specific reports with more detailed results. 

Overall, 53% of CAHs were participating in Hospital Compare (by submitting data on at least one measure) as of September 2006, a substantial increase from 41% in September 2005. By state, the percent of participating CAHs ranges from 0% to 100%. The Hospital Compare measure set for 2005 discharges included 20 measures that reflect recommended treatments for acute myocardial infarction (heart attack or AMI), heart failure, pneumonia and surgical infection prevention. Although the number of CAH patients for whom measures were reported had increased since the previous year, many CAHs still had a very small number of patients for several measures. Therefore, aggregate scores were calculated across groups of CAHs and other hospitals.

The second year results are similar to the initial year results. CAHs are not doing as well on the AMI and heart failure measures as rural and urban Prospective Payment System (PPS) hospitals. For pneumonia and surgical infection prevention, CAHs scored as well or better than other hospitals on some measures, and not as well on a few measures.

Over the two years, all groups of hospitals showed significant positive increases in the percent of patients receiving recommended care for the majority of quality measures. Of the 19 measures for which CAHs had data for both years, 13 measures had significant positive increases in the percent of patients who received recommended care. The largest increases were for the AMI smoking cessation advice, surgical infection prevention and pneumoccal vaccination measures. Five measures had increases that were not statistically significant, while one had a non-significant decrease. Rural and urban PPS hospitals showed significant positive increases for nearly all measures.

CAHs still have room for improvement, especially with regard to recommended care for AMI and heart failure patients. However, it is encouraging that the group of CAHs that reported Hospital Compare data for both years significantly improved their performance on almost all pneumonia, heart failure, and surgical infection measures.

Low volume remains a problem for calculating a number of measures, especially AMI measures, at the individual hospital level, and also will limit the usefulness of some new measures being added to Hospital Compare, such as 30-day mortality rates for AMI and heart failure. Additional research is needed to identify alternative methods of assessing and comparing quality performance at the hospital level for small rural hospitals. This research will be especially important as the CMS Medicare Value-based Purchasing initiative is developed and implemented.