Death rates rise at geographically isolated hospitals, study finds

April 3, 2013 in Medical Technology

By Jordan Rau, KHN Staff Writer

This KHN story was produced in collaboration with

For 15 years, Congress has bestowed special privileges to some small remote hospitals, usually in rural areas, to help them stay afloat. Medicare pays them more than it pays most hospitals and exempts them from financial pressure to operate efficiently and requirements to reveal how their patients fare. Nearly one in four hospitals qualifies for the program.

Despite these benefits, there’s new evidence that the quality of many of these hospitals may be deteriorating. A study published Tuesday found that during the past decade the death rates of patients at these critical access hospitals were growing while mortality rates at other hospitals were dropping.

“This carved-out group of hospitals seems to be falling further and further behind,” said the paper’s lead author, Dr. Karen Joynt of the Harvard School of Public Health. 

[See also: Leapfrog grades hospitals A to F on patient safety.]

The study, published in the Journal of the American Medical Association, found that in 2002, mortality rates at critical access hospitals for Medicare patients with heart attacks, heart failure and pneumonia were about the same as at other hospitals. But they have diverged since then.

While death rates at other hospitals dropped by 0.2 percent a year, reaching 11.4 percent in 2010, mortality rates at critical access hospital death rates rose about 0.1 percent each year, reaching 13.3 percent in 2010. Critical access hospitals also did worse than other small, rural hospitals that were not in the program. The paper said all these results were statistically significant.

Joynt and her co-authors, John Orav and Dr. Ashish Jha, also of Harvard, suggested that the hospitals’ care may suffer because they don’t have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations. A previous paper by the trio found that critical access hospitals were less likely to have the ability to perform cardiac catheterizations and to have intensive care units.

“As we have more advanced treatments, it’s harder for rural hospital to keep up,” Joynt said. “It’s hard to provide care for really, really sick patients in a resource-limited setting.”

She also suggested that the hospitals may have been victims of their lenient treatment by the government. Since hospital officials are not required to evaluate their performances to make reports to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients.

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