Since the release of the article entitled, “Mortality Rates for Medicare Beneficiaries Admitted to Critical Access Hospitals and Non-Critical Access Hospitals, 2002-2010” in the Journal of the American Medical Association (JAMA) on April 3, 2013 there has been a keen interest on what it means and its implications.
Kaiser Health News first reported on the story and it was picked up by many news outlets, including USA Today. Modern Healthcare’s Editor Merrill Goozner wrote an editorial on the topic this week. Last but not least, NRHA’s former President Wayne Myers wrote a nice article for the Daily Yonder.
At first, my reaction was one of disbelief and anger, how could JAMA and the team at Harvard slam CAH’s once again? Next was to question the data, now entering into the denial stage. Of course, I’m not an expert in research methods, so I quickly realized that this was futile. There was some depression mixed in as well, I suppose.
But upon further reflection and interaction with members of the media, I realized that this could be a learning moment for those not initiated into the realities of rural hospital quality. NRHA and its partners have long been involved in improving quality in rural hospitals. NRHA’s Policy Brief outlines a detailed approach to our vision for quality. Reminding ourselves of the work that we’ve done gives a glimpse on what is left to do.
Since this Policy Brief was released in 2007, several major advances were made to assist us in our cause. The first is that Ira Moscovice, Ph.D. and the FLEX Monitoring team at the University of Minnesota released a 2012 report that gives a set of agreed upon rural relevant quality measures. We can no longer be satisfied to use measures designed for large, urban hospitals and expect them to be meaningful in a small-volume facility.
Second, the Office of Rural Health Policy (ORHP) has initiated the Medicare Beneficiary Quality Improvement Program designed to get all 1,330 CAH’s to participate voluntarily in quality reporting. It’s impressive that so many CAH’s are voluntarily committing to this project. This is a demonstration of CAH’s willingness to improve their performance without incentive or coercion.
Finally, NRHA will be hosting it's second annual Top 20 CAH awards at our Annual CAH meeting, featuring the Top 20 CAH's in each of three categories: quality, financial strength and patient satisfaction. This is a program designed to feature best practices by identifying those CAH's that have excelled in these 3 areas of performance.
We’ve been lone voices crying in the wilderness. Due to the JAMA article perhaps we can engage on a broader level to get the attention that we need to assist us in our cause. In fact, we can join with the JAMA article’s authors and agree that “new policy initiatives may be needed.” Indeed, let’s turn lemons into lemonade, our rural communities and patients depend on it.