It is generally accepted that approximately 17 percent of the U.S. population currently lives in “rural” areas. Small, low-volume hospitals serving these areas face a number of well-documented challenges in their efforts to deliver high-quality care.
Historically, finances and limited clinical resources have been major obstacles to the provision of quality health care at rural hospitals.1 A momentous action was the designation of many small rural facilities as Critical Access Hospitals (CAHs) through the Balanced Budget Act of 1997. This designation primarily assists these hospitals financially with extremely favorable Medicare reimbursement (101 percent of reasonable costs). Rural facilities are also uniquely eligible for a number of other targeted assistance programs. Given economic incentives alone, it is not surprising that CAHs currently account for over 25 percent of acute care hospitals in the U.S.
A major public health issue is how care at rural hospitals compares to that delivered at...