Minimum-Distance Requirements Could Harm High-Performing Critical-Access Hospitals And Rural Communities

作者：Casey Michelle M^*; Moscovice Ira; Holmes G Mark; Pink George H; Hung Peiyin

来源：Health Affairs, 2015, 34(4): 627-635.

DOI：10.1377/hlthaff.2014.0788

Since the inception of the Medicare Rural Hospital Flexibility Program in 1997, over 1,300 rural hospitals have converted to critical-access hospitals, which entitles them to Medicare cost-based reimbursement instead of reimbursement based on the hospital prospective payment system (PPS). Several changes to eligibility for critical-access status have recently been proposed. Most of the changes focus on mandating that hospitals be located a certain minimum distance from the nearest hospital. Our study found that critical-access hospitals located within fifteen miles of another hospital generally are larger, provide better quality, and are financially stronger compared to critical-access hospitals located farther from another hospital. Returning to the PPS would have considerable negative impacts on critical-access hospitals that are located near another hospital. We conclude that establishing a minimum-distance requirement would generate modest cost savings for Medicare but would likely be disruptive to the communities that depend on these hospitals for their health care.

• 出版日期2015-4