​Critical access hospitals had significantly fewer rates of serious complications and lower Medicare expenditures despite a lack of statistically significant differences in 30-day mortality rates compared to non-critical-access hospitals, according to a study published on May 17, 2016 in JAMA that compared the outcomes and Medicare-related costs for four common surgical procedures. The authors performed a cross-sectional review of over 1.6 million Medicare beneficiary admissions to critical access and non-critical-access hospitals between 2009 and 2013 for appendectomy (3,467 for critical access, 151,867 for non-critical-access), cholecystectomy (10,566 for critical access and 573,435 for non-critical-access), colectomy (10,198 for critical access and 577,680 for non-critical-access), and hernia repair (4,291 for critical access and 300,410 for non-critical-access).  Compared with non-critical-access hospitals, critical access hospitals had lower rates of in-hospital mortality (2.9% versus 3.9%), lower Medicare payments for common surgical procedures ($15,094 versus $21,074), and no statistical difference in 30-day mortality. In addition, critical access hospitals had lower rates of serious complications (6.4% versus 13.9%) and overall complications (17.5% versus 25.4%), but they also had higher rates of readmission within 30 days. The authors note that patients presenting for surgery at critical access hospitals were less likely to have chronic medical problems and had lower rates of heart failure, diabetes, obesity, and multiple comorbid diseases. 

HRC Recommends: As smaller hospitals such as critical access hospitals provide more clinically complex services to meet financial goals, it's important to ensure that quality standards remain high (see the January 6, 2016, HRC Alerts). Healthcare organizations of any size should monitor their performance in regard to complex services, and surgical volume may be one factor to consider when analyzing performance data. After analyzing data, healthcare organizations should undertake patient safety and quality improvement projects to address identified risks and continually reevaluate performance.