Rural Hospital Flexibility Program Evaluation Plan (2000)

Denny DeGross, MA
Beth Landon, MBA, MHA

Critical Access Hospitals (CAHs), as allowed under the Rural Hospital Flexibility Act, are "devolved" small, rural hospitals, who would likely have difficulty surviving under the stipulated change to prospective Medicare reimbursement required by the Balanced Budget Act of 1997. They are different from other hospitals because, unlike their larger, more urban cousins, they will continue to receive reasonable cost-based Medicare reimbursement for their services. Some Alaskan hospitals may convert if they foresee the conversion improving their sustainability without negatively affecting access or quality of care.

In Alaska, up to 12 hospitals (Cordova, Kanakanak, Maniilaq, Norton Sound, Petersburg, Kodiak, Seward, Samuel Simmonds, Sitka, South Peninsula, Valdez and Wrangell) are potentially eligible to participate in the Medicare Critical Access Hospital Program (CAH) and convert to a "CAH". Examining the process for deciding whether or not to convert, and the impact of that decision, will provide useful insights to future policy decisions in Alaska. Thus, the evaluation of this program and its implementation are important tools for planning the next steps in rural health systems’ development and support when the Rural Hospital Flexibility Program grant ends. In short, the evaluation of "CAH" could be nearly as valuable as the program itself in the maintenance and improvement of Alaska’s health care delivery system.