The Critical Access Hospital program is a United States federal program established in 1997 as part of the Balanced Budget Act. The program aims to offer small hospitals in rural areas to serve residents that would otherwise be a long distance from emergency care.
As of January 2018, there are 1,343 certified Critical Access Hospitals in 45 states. Connecticut, Delaware, Maryland, New Jersey and Rhode Island do not have any CAHs. [1]
To receive federal funding, Critical Access Hospitals must adhere to several guidelines. They may have no more than 25 beds and must have an average duration of hospital stay under 96 hours. [2] They must also be more than 35 miles from another hospital, with exceptions allowed for areas with poor roads or difficult terrain. [3]
CAHs have more flexibility than other hospitals in staffing requirements. They must offer 24/7 emergency care and have a physician on-call available to be on-site within 60 minutes. [4] They are required to have a Registered Nurse on site at all times when acutely ill patients are in the hospital. At other times, a Licensed Practical Nurse (LPN) may fill in. [5]
In most cases, a Doctor of Medicine or Doctor of Osteopathic Medicine, a physician assistant, a nurse practitioner, or a clinical nurse specialist (defined as a nurse with at least a master's degree in nursing) must be available for immediate contact by phone or radio. The provider must be able to be on-site within 30 minutes unless it is an area designated by the census as a "frontier area" or if the state has determined that it is not possible for the hospital to keep staff available within 30 minutes, and a registered nurse is available on-site. In CAHs with 10 or fewer beds, a registered nurse with training in emergency care is allowed to fulfill the role of the on-call physician. [6]
Critical access hospitals must have all the equipment and medications required for essential medical treatment, and have agreements in place with larger hospitals for the transport of patients in need of further care. [6]
Pharmaceutical companies are legally required to pay for a portion of the medications used by critical access hospitals as part of the 340B Drug Pricing Program.
Few CAHs provide intensive care treatment. A review of CAHs in the early 2000s counted 26% of the hospitals providing intensive care-level treatment to at least one patient. About two-thirds of these hospitals had a physical intensive care unit, while the remainder provided intensive care treatment in areas of the hospital also treating acute care patients. The mean number of intensive care beds in each hospital was 3.5. Two-thirds of the hospitals providing intensive care treatment staffed these areas with registered nurses only. Most of the hospitals providing intensive care services also provided surgical services. [7]
The program was created with the Balanced Budget Act of 1997, and modified with the Balanced Budget Refinement Act of 1999. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 increased reimbursement for CAHs to 101% of care costs. The Medicare Improvements to the Patients and Providers Act of 2008 expanded grants available to CAHs and further incentivized reimbursement. [8]
A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respiratory therapists graduate from a college or university with a degree in respiratory therapy and have passed a national board certifying examination. The NBRC is responsible for credentialing as a CRT, or RRT in the United States. The CBRC is responsible for credentialing as an RRT in Canada.
Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency medicine physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.
Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).
Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.
A Federally Qualified Health Center (FQHC) is a community-based health care organization that provides comprehensive primary care and support services to underserved populations in the United States. These centers serve patients regardless of immigration status, insurance coverage, or ability to pay. FQHCs are a key component of the nation's primary care safety net and aim to reduce barriers to health care access for low/moderate-income and minority populations.
A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion.
A public hospital, or government hospital, is a hospital which is government owned and is predominantly funded by the government and operates predominantly off the money that is collected from taxpayers to fund healthcare initiatives. In almost all the developed countries but the United States of America, and in most of the developing countries, this type of hospital provides medical care almost free of charge to patients, covering expenses and wages by government reimbursement.
Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions.
In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.
In the United States, anesthesia can be administered by physician anesthesiologists, an anesthesiologist assistant, or nurse anesthetist.
A flight nurse is a registered nurse specializing in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally provided during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft, or jet aircraft. On board a rescue aircraft, is a flight nurse, accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more common in pediatric and neonatal transport teams. A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site, the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather. Some patients may experience exacerbations because of factors related to the cabin environment, including hypoxia, limited mobility, gas expansion, and the risk of injury related to turbulence. Resources for definitive care are limited. Aeromedical evacuation crews coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients with trauma and mental health illnesses.
A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care.
In the United States, hospice care is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual, or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. Hospice care was introduced to the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. This part of health care has expanded as people face a variety of issues with terminal illness. In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.
A rural health clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate reimbursement structure from the standard medical office under the Medicare and Medicaid programs. RHCs were established by the Rural Health Clinic Services Act of 1977, . The RHC program increases access to health care in rural areas by
Massac Memorial Hospital is a 25-bed general medical and surgical hospital located in Metropolis, Illinois, United States. In 2011, the hospital had 1,002 admissions, 10,031 emergency department visits, and 25,365 outpatient visits.
A pediatric nurse practitioner (PNP) is a nurse practitioner who specializes in care for newborns, infants, toddlers, preschoolers, school-aged children, adolescents, and young adults. Nurse practitioners have an in-depth knowledge and experience in pediatric healthcare including well childcare, and prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to support optimal health of children within their community. In order to be a pediatric nurse practitioner, one must be compassionate, resourceful, good at communicating and have good attention to detail.
The Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative (PQRI), is a health care quality improvement incentive program initiated by the Centers for Medicare and Medicaid Services (CMS) in the United States in 2006. It is an example of a "pay for performance" program which rewards providers financially for reporting healthcare quality data to CMS. PQRS ended in 2016, beginning with the 2018 payment adjustment. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced this and other CMS quality programs with a new umbrella program called the Quality Payment Program (QPP), under which clinicians formerly reporting under PQRS would instead report quality data under one of two QPP program tracks: the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APMs) track.
Deemed status is a hospital accreditation for hospitals in the United States.
A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Generally, higher readmission rate indicates ineffectiveness of treatment during past hospitalizations. Hospital readmission rates were formally included in reimbursement decisions for the Centers for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence At Home Demonstration Program, and Bundled Payments for Care Improvement Initiative are all examples of these programs. While many time frames have been used historically, the most common time frame is within 30 days of discharge, and this is what CMS uses.
The United States has many regions which have been described as medical deserts, with those locations featuring inadequate access to one or more kinds of medical services. An estimated thirty million Americans, many in rural regions of the country, live at least a sixty-minute drive from a hospital with trauma care services. Regions with higher rates of Medicaid and Medicare patients, as well those who lack any health insurance coverage, are less likely to live within an hour of a hospital emergency room. Although concentrated in rural regions, health care deserts also exist in urban and suburban areas, particularly in predominantly Black communities in Chicago, Los Angeles and New York City. Racial demographic disparities in healthcare access are also present in rural areas, particularly in Native American communities which experience worse health outcomes and barriers to accessing quality medical care. Limited access to emergency room services, as well as medical specialists, leads to increases in mortality rates and long-term health problems, such as heart disease and diabetes.