CAH Year 6 Hospital Compare Participation and Quality Measure Results (Briefing Paper #28)

Publication Date: Apr 2011
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 2009 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.  This updates previous national reports on Hospital Compare results for CAHs.


For 2009 discharges, a total of 933 CAHs (71.1%) submitted data on at least one inpatient measure to Hospital Compare. The overall CAH participation rate of 71% on inpatient process measures for 2009 discharges compares to previous rates of 41% (2004); 53% (2005), 63% (2006), 69% (2007), and 70% (2008). By state, the percent of participating CAHs ranged from 11% to 100%. Six states had 100% of their CAHs participating. CAHs remain more likely to report data on pneumonia and heart failure measures than on AMI and surgical infection prevention measures. A total of 209 CAHs submitted data to Hospital Compare on at least one outpatient process of care measure. By state, the percent of CAHs reporting outpatient process of care measures ranged from 0% to 46%.

For 2009 discharges, CAHs did not perform as well as did rural and urban PPS hospitals on many measures. Although the percent of CAH patients receiving recommended care increased from 2006-2009 for 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, 35% of CAHs publicly reported HCAHPS survey data to Hospital Compare in 2009. By state, the percent of CAHs publicly reporting HCAHPS data ranged from 0% to 100% of CAHs in 2009. 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.