Critical Access Hospitals


Part of a rural health safety net


Of the 157 hospitals in Oklahoma, 36 are designated as Critical Access. A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than non CAH acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, seven-day-a-week emergency care; and being located in a rural area, at least a 35 mile drive away from any other hospital or CAH (fewer miles in some specific circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. 

Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This enhanced reimbursement is due to typically lower volumes of patients and the types of services provided by the CAH. Enhanced reimbursement allows the CAH to remain viable as a source of emergency and ordinary care for the residents of that rural area, who tend to be poorer than their urban counterparts. 

Economic impact of Critical Access Hospitals


Access to health care is one of the main factors of economic development. When an outside entity looks to invest in a community, they look at workforce availability, infrastructure, and access to health care. If one of these is missing, that entity will bypass that community and possibly the state. Communities that are fortunate to have a CAH already enjoy a significant economic impact. The CAH is generally one of the largest employers in that community. An assessment done in 2013-14 by OSU Extension and the Oklahoma Office of Rural Health of nine CAHs representing seven counties provided the following average data:
  • Direct economic impact per CAH $3,829,235
  • Secondary economic impact per CAH $689,262
  • Total economic impact per CAH $4,518,498
Taking that average total economic impact and multiplying it by the 36 CAHs in Oklahoma results in a total annual economic impact of $162,665,928 for the state.