This policy brief profiles 2008 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 current Hospital Compare quality measures include inpatient process of care measures that reflect recommended treatments for acute myocardial infarction (AMI), heart failure, pneumonia, surgical care improvement, and children’s asthma care; outpatient AMI/chest pain and surgical process of care measures; Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results; and hospital 30 day risk-adjusted mortality and readmission rates for AMI, heart failure, and pneumonia calculated by CMS using Medicare claims data.  The report updates previous national reports on Hospital Compare results for CAHs.  There is also a full-length briefing paper detailing these same Year 5 findings.

Key Findings:

• 70% of CAHs reported data for at least one patient on one inpatient process of care measure for 2008. The percent of CAH patients receiving recommended care has increased for nearly all measures. At the same time, the percent of PPS patients receiving recommended care has also increased, so CAHs continue to have lower scores relative to rural and urban PPS hospitals on several measures.
• 34% of CAHs reported HCAHPS patient assessment of care survey data in 2008. On average, CAHs have significantly higher ratings on HCAHPS measures than all US hospitals.
• The vast majority of CAHs either did not have enough cases in 3 years for CMS to reliably calculate 30-day risk adjusted mortality and readmission rates for pneumonia, heart failure and AMI, or did not have rates that were significantly different than the US rates for all hospitals. Thus, these measures are of limited usefulness for assessing quality at the individual hospital level for CAHs. 
• Health care providers will increasingly be required to demonstrate the quality of the care they are providing to qualify for reimbursement incentives and avoid penalties for poor care. In this environment, CAHs that are unwilling to participate in quality reporting and benchmarking activities may be at a disadvantage.