Critical access hospitals ahead on Medicare surgical outcomes

Despite earlier reports that indicated mortality rates for inpatient surgeries are higher at critical access hospitals, a new study published in the Journal of the American Medical Association suggests that these facilities may provide Medicare patients better surgical outcomes at lower costs.

Researchers from the University of Michigan, led by Justin Dimick, M.D., analyzed 1.6 million hospital stays for four common operations: hernia repair, appendectomies, gallbladder removals and colon surgeries. The procedures took place at 828 CAHs and 3,600 larger providers. The analysis found the 30-day mortality risk was the same for both hospital types, whereas the risk of major post-surgical complications was lower for CAHs. Furthermore, operations at CAHs cost Medicare significantly less than patients at larger hospitals, a difference of about $1,400 after adjusting for pricing and patient risk.

Part of the reason for the improved outcomes at CAHs appears to be that by and large, the patients were healthier than the other surgical patients to begin with, according to the study. Researchers said this indicates that surgeons at CAHs apply more scrutiny in selecting patients likely to do well in that setting while triaging less healthy patients to larger hospitals. The study also found that CAHs had outcomes equal or better to their larger counterparts after adjusting the data for differences in pre-surgery health. The researchers also noted that less than 5 percent of CAH surgical patients are transferred, compared to 1 in 4 non-surgical patients.

"From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care," co-author Andrew Ibrahim, M.D., said in a statement. The study echoes similar 2014 research that found rural hospitals have equal outcomes to their urban counterparts and superior emergency care, FierceHealthcare previously reported.

To learn more:
- read the study abstract
- here's the statement