Among critical access hospitals, big spending and network affiliation determine advanced imaging access

Many rural hospitals with less than 25 inpatient beds and at least a 35-mile drive away from any other hospital are certified as critical access hospitals (CAHs). CAHs receive larger reimbursements from Medicare, and they have been shown to provide improved care and hospital access to underserved communities.

All CAHs provide basic imaging services, but not all of them provide advanced services such as MRI, CT, ultrasound, or mammography. So what determines which imaging services a CAH is able to provide?

Amir A. Khaliq, PhD, University of Oklahoma Health Sciences Center, and colleagues asked this exact question for a study published in the special December issue of the Journal of the American College of Radiology (JACR).

Khaliq et al. analyzed data from the American Hospital Association and American Hospital Directory from 2009-2011, and they found that CAHs spending more money and participating in larger healthcare systems or networks tend to provide more advanced imaging services to patients.

“All things equal, CAHs were 13 percent more likely to have MRI available, 11 percent were more likely to have mammography available, and 4 percent were more likely to have PET/CT available for each $1 million increase in total expenditures,” the authors wrote.

The authors’ research also showed how important a role network affiliation can play for a CAH.

“Network CAHs were 75 percent more likely to have MRI, 117 percent more likely to have CT available, 103 percent more likely to have ultrasound available, and twice as likely to have mammography available,” the authors wrote. “Our findings reinforce previous findings that CAHs rely on network participation and service diversification to meet community needs.”

The data revealed one exception to this trend; network affiliation did not result in a sharp increase in the availability of PET/CT capabilities. Khaliq and colleagues attributed this to the rural nature of so many CAHs.

“There may simply be insufficient patient volumes to justify this highly specialized service, which is most frequently used in the setting of follow-up for very select cancers,” the authors wrote. “Overall, however, rural status was not a significant determinant for the other imaging services.”

The data also revealed a negative association between impatient revenue share and imaging service access.

“This finding is likely attributable to hospitals’ increasing shift from inpatient services to more profitable outpatient services, causing the share of inpatient services to shrink over time while providing additional resources to invest in additional imaging services,” the authors wrote.