CAH Year 5 Hospital Compare Participation and Quality Measure Results (Briefing Paper #26)

Publication Date: Mar 2010
Author(s): Casey MM, Burlew M, Moscovice IS
Research Center(s): Minnesota
Project: Analyzing Quality Reporting and Improvement of CAHs
Topic(s): Hospital Compare, Quality

This report examines 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 policy brief profiling these same Year 5 findings.


For 2008 discharges, 70% of CAHs participated in Hospital Compare by submitting data for at least one patient on one inpatient process of care measure. By state, the percent of participating CAHs ranged from 11% to 100%. Eight states had 100% of their CAHs participating. CAHs were more likely to report data on pneumonia and heart failure measures than on AMI and surgical infection prevention measures. The overall CAH participation rate of 70% for 2008 discharges compares to previous rates of 41% (2004); 53% (2005), 63% (2006) and 69% (2007).

For 2008 discharges, CAHs did not perform as well as did rural and urban PPS hospitals on many inpatient process of care measures. Although the percent of CAH patients receiving recommended care increased from 2005-2008 for nearly all measures, the percent of rural and urban PPS hospital patients receiving recommended care also increased during this time period. Thus, while showing improvement, CAHs continued to have lower scores relative to rural and urban PPS hospitals on most measures.

In addition, 34% of CAHs publicly reported HCAHPS survey data to Hospital Compare in 2008. By state, the percent of CAHs publicly reporting HCAHPS data ranged from 0% to 100% of CAHs in 2008. On average, CAHs have significantly higher ratings on HCAHPS measures than all US hospitals. The vast majority of CAHs did not have enough cases 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.