Back in 1997, Congress initiated the so-called critical-access program, which granted a series of special privileges to rural hospitals throughout the U.S. The overarching goal of the program was to keep hospital doors open in those places where patients had no viable alternative that was closer than 35 miles away by primary roads or 15 miles away by secondary roads.

The main qualification for enrollment in the program is that the hospital have 25 beds or fewer and, of course, be located in a rural area. As of 2011, 1,331 U.S. hospitals qualified for the critical-access program, with the most being found in the Midwest.

Two of the more notable special privileges enjoyed by critical-access hospitals include complete reimbursement for all Medicare patients, plus 1 percent (a significantly higher rate than other U.S. hospitals), and exemption from Medicare reporting requirements.

A recently published study in the Journal of the American Medical Association reveals that the quality of care provided at these critical-access hospitals may actually be worsening despite these rather generous concessions.

Performed by researchers at the Harvard School of Public Health, the study compared the mortality rates of Medicare patients who were diagnosed with heart attacks, heart failure or strokes and treated at critical-access hospitals with the same set of patients treated at standard U.S. hospitals.

Researchers found that the mortality rates between the two sets of Medicare patients were largely the same in 2002. However, over the course of the next eight years, the mortality rates at the critical-access hospitals rose a shocking 13.3 percent, while the mortality rates at the standard U.S. hospitals fell by 11.4 percent.

The researchers believe that this large discrepancy can be traced to the simple fact that many critical-access hospitals are lacking both advanced medical technology and access to specialists to treat their largely elderly population.

“As we have more advanced treatments, it’s harder for rural hospitals to keep up,” said Dr. Karen Joynt, one of the study’s primary researchers. “It’s hard to provide care for really, really sick patients in a resource-limited setting.”

Another theory advanced by the researchers is that critical-access hospitals’ exemption from Medicare reporting may be causing more harm than good because it fails to alert federal officials that further financial assistance is needed to provide improved patient care.

To improve the quality of care at critical-access hospitals, the researchers suggest increased Medicare reporting, better patient transfer systems and the introduction of telemedicine, in which specialists are consulted via the Internet.

Always remember that everyone, whether they live in the big city or the country, deserves safe and excellent care.

Have you ever received care at a rural hospital? What was your experience? Did you feel that the quality of care was lacking?

Please visit our website if you or a family member has been victimized by hospital negligence.

Source: The Lincoln Journal Star, “Death rates rise at geographically isolated hospitals, study finds,” Jordan Rau, April 7, 2013