Examine Critical Access Hospital Payment Policies Within the Context of Integrated Systems.

To prevent closings of critical access hospitals (CAHs), or rural hospitals, Congress authorized cost-based rather than prospective payments. This commentary responds to research suggesting that when CAHs join integrated systems, the relative portion of a system's costs of shared services attributed to CAHs increased by 40 percent. The finding highlights the need to examine payments to integrated delivery systems that support CAHs as part of a continuum of care in rural communities.