title: Variations in financial performance among peer groups of critical access hospitals.
abstract: BACKGROUND
  Among the large number of hospitals with critical access hospital (CAH) designation, there is substantial variation in facility revenue as well as the number and types of services provided. If these variations have material effects on financial indicators, then performance comparisons among all CAHs are problematic.
  
  
  OBJECTIVE
  To investigate whether indicators of financial performance and condition systematically vary among peer groups of CAHs.
  
  
  METHODS
  Suggestions from CAH administrators, a literature review, expert panel advice, and statistical analysis were used to create peer groups based on whether a CAH: (1) had less than $5 million, $5-10 million, or over $10 million in net patient revenue; (2) was owned by a government entity; (3) provided long-term care; and (4) operated a provider-based Rural Health Clinic.
  
  
  RESULTS
  Significant differences in financial performance and condition exist among CAH peer groups.
  
  
  CONCLUSIONS
  CAHs should ensure that they use appropriate peer comparators when assessing their financial performance and condition. If quality, outcome, safety and access are affected by financial performance and condition, it may also be important for research in these areas to control for peer group differences among CAHs.
authors.affiliation: North Carolina Rural Health Research and Policy Analysis Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590, USA. gpink@schsr.unc.edu
authors.forename: George H
authors.initials: GH
authors.lastname: Pink
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
authors.forename: Roger E
authors.initials: RE
authors.lastname: Thompson
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Slifkin
mesh_terms: D017598:Efficiency, Organizational / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration; D014481:United States