The Impact of Hospital Characteristics on the Availability of Radiology Services at Critical Access Hospitals

Khaliq, Amir A.; Deyo, Darwyyn; Duszak, Richard

doi:10.1016/j.jacr.2015.09.008

Cited by 22 publications

(11 citation statements)

References 12 publications

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“…An acute care general hospital can be designated a CAH by Medicare if it (1) is located in a rural area with a State Medicare Rural Hospital Flexibility Program, (2) provides 24-hour emergency care services using on-site or on-call staff members, (3) has no more than 25 inpatient beds, (4) has an average annual length of stay of 96 hours or less, and (5) is located more than 35 miles from the nearest hospital (15 miles in mountainous terrain) or is state certified as a necessary provider. Evidence suggests that CAHs have improved rural access to medical care, including to imaging services [ 23 ]. A recent report on critical access hospitals showed that 95% of CAH have a CT scanner and 83% can perform MRIs [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Rural versus urban academic hospital mortality following stroke in Canada

et al. 2018

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IntroductionStroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada.ObjectivesTo describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals.Materials and methodsWe included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate.ResultsA total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities.ConclusionRural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada’s universal health care system.

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Section: Discussionmentioning

confidence: 99%

Rural versus urban academic hospital mortality following stroke in Canada

et al. 2018

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“…CT utilization has been shown to cluster regionally, 6 with rural regions less likely to provide imaging services. 20 Smokers in rural areas are already known to be an at‐risk group for poor LDCT screening. 21 Our results reflect these regional differences, as the median population of VA stations providing higher LDCT rates was about 2× the median population of those that had lower LDCT rates.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the clinical trends and benefits of low‐dose computed tomography in lung cancer patients

et al. 2021

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“…Next, we found geographic variations in costs by comparing urban, rural, and critical access hospital status as defined by the CMS [4]. Previous studies have suggested that access to care for advanced imaging is a concern for rural and critical access hospitals [16,17,22], which may be directly attributable to the relatively high cost of purchasing and maintaining advanced imaging modalities in low-utilization areas [26]. Urban-rural discrepancies in the orthopaedic workforce have been noted previously, with fewer orthopaedic surgeons practicing in rural areas of the country which might affect access to quality orthopaedic care in these areas [11].…”

Section: Discussionmentioning

confidence: 99%

What Does a Shoulder MRI Cost the Consumer?

Westermann

Schick

Graves

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background More than 100 MRIs per 1000 inhabitants are performed in the United States annually, more than almost every other country. Little is known regarding the cost of obtaining an MRI and factors associated with differences in cost. Questions/Purposes By surveying all hospital-owned and independent imaging centers in Iowa, we wished to determine (1) the cost to the consumer of obtaining a noncontrast shoulder MRI, (2) the frequency and magnitude of discounts provided, and (3) factors associated with differences in cost including location (hospital-owned or independent) and Centers for Medicare & Medicaid Services designation (rural, urban, and critical access).Methods There were 71 hospitals and 26 independent imaging centers that offered MRI services in Iowa. Each site was contacted via telephone and posed a scripted request for the cost of the technical component of a noncontrast shoulder MRI. Radiologists' reading fees were not considered. Statistical analysis was performed using standard methods and significance was defined as a probability less than 0.05. Results The mean technical component cost to consumers for an MRI was USD 1874 ± USD 694 (range, USD 500-USD 4000). Discounts were offered by 49% of imaging centers, with a mean savings of 21%. Factors associated with increased cost include hospital-owned imaging centers (USD 2062 ± USD 664 versus USD 1400 ± USD 441 at independent imaging centers; p \ 0.001; mean difference, USD 662; 95% CI, USD 351-USD 893) and rural imaging centers, unless designated as a critical access hospital (USD 2213 ± USD 668 versus USD 1794 ± USD 680; p = 0.0202; mean difference, USD 419; 95% CI, USD 66-USD 772). Conclusions In Iowa, the cost to the consumer of a shoulder MRI is significantly less at independent imaging centers compared with hospital-owned centers. Referring physicians and healthcare consumers should be aware that there may be substantial price discrepancies between centers that provide advanced imaging services.

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The Impact of Hospital Characteristics on the Availability of Radiology Services at Critical Access Hospitals

Abstract: Total hospital expenditures and network participation are important determinants of whether CAHs provide certain imaging services. Encouraging CAHs' participation in larger systems or networks may facilitate access to highly specialized services in rural and underserved areas.

Cited by 22 publications

References 12 publications

Rural versus urban academic hospital mortality following stroke in Canada

Rural versus urban academic hospital mortality following stroke in Canada

Evaluating the clinical trends and benefits of low‐dose computed tomography in lung cancer patients

What Does a Shoulder MRI Cost the Consumer?

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