Rural Hospital Flexibility Program 
Tracking Project
Year Two Report

The Tracking Project was funded by the 
Federal Office of Rural Health Policy, 
Health Resources and Services Administration 
(Cooperative Agreement #6U27 RH 00235).

Tracking Project Team

Acknowledgements

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Table of Contents

Executive Summary

Introduction

Chapter 1: The Evolving State Role in the Implementation of the Rural Hospital Flexibility Program  

Chapter 2: A Profile of Critical Access Hospitals

Chapter 3: Critical Access Hospital Issues

Chapter 3A:  Hospital Conversion Processes

Chapter 3B:  Scopes of Services in Critical Access Hospitals

Chapter 3C:  Critical Access Hospital Network Development

Chapter 3D: Local Networking Strategies Used by Critical Access Hospitals

Chapter 3E:  Financial Condition of Critical Access Hospitals: 1996-2000

Chapter 3F:  Major Strengths, Problem Areas, and Strategic Initiatives: A Balanced Scorecard Perspective

Chapter 3G:  CAH Quality Assurance (QA) and Quality Improvement (QI) Strategies

Chapter 3H:  Physician Perceptions of the Critical Access Hospital

Chapter 3I:  Administration in Critical Access Hospitals

Chapter 4: EMS Activities Under the Rural Hospital Flexibility Program

Chapter 5: Critical Access Hospitals and Community Development

Chapter 6: Small Rural Hospitals that Have Chosen Not to Convert to CAH Status

Conclusions from Year 02

Appendices:

A. Dissemination of Rural Hospital Flexibility Program Tracking Project Findings (RUPRI)
B. Content of State Applications
C. Site Visits
D. Protocols and Survey Instruments:

1. State Site Visit Interview Protocols

2. Pre-Site Survey Instrument - Hospital Level (PDF File)

3. Hospital Site Visit Interview Protocols (PDF File)

4. Strategic and Financial Information Collected During Hospital Site Visits

5. Emergency Medical Services Information Collected During State and Hospital Site Visits

6. Follow-up Interview Questions for Year One Informants

7. Critical Access Hospital Telephone Survey Protocol (PDF File)

8. Physician Survey (PDF File)

E. Findings from the Field 
F. Year 03 Project Proposal List

The Tracking Project team is made up of staff from the following centers:

Project HOPE Walsh Center for Rural Health Analysis (HOPE)

• Penny E. Mohr, M.A. 

• Curt D. Mueller, Ph.D.

• Julie A. Schoenman, Ph.D.

Rural Policy Research Institute (RUPRI)

• Keith J. Mueller, Ph.D.

University of Minnesota Rural Health Research Center (UM)

• Walter R. Gregg, M.A., M.P.H.

• Ira Moscovice, Ph.D.

University of North Carolina Rural Health Research and Policy Analysis Program (UNC)

• Andrew E. Cameron, Ph.D.

• Kathleen Dalton, Ph.D.

• Melissa Fruhbeis, M.S.P.H.

• Hilda Howard, B.S.

• Stephanie Poley, B.A.

• Thomas C. Ricketts, Ph.D.

• Scott R. Stewart, M.S.P.H.

• William N. Zelman, Ph.D.

University of Southern Maine Rural Health Research Center (USM)

• Andrew F. Coburn, Ph.D.

• John A. Gale, M.S.

• David Hartley, M.H.A., Ph.D.

WWAMI Rural Health Research Center (UW)

• Debbie Duncan, B.A.

• Amy Hagopian, M.H.A.

• Gary Hart, Ph.D.

• Peter House, M.H.A.

• Denise Lishner, M.S.W.

Acknowledgements

The Tracking Team would like to gratefully acknowledge the Critical Access Hospitals that participated in this project by graciously hosting our site visitors and by answering the telephone survey. We also appreciate the state offices of rural health and other agencies and organizations that spent time with us on site visits, and all physicians who responded to our survey of CAH-affiliated physicians.

Our advisory committee spent countless hours on telephone conference calls and read drafts of our chapters, and for that we are thankful: Hervey Davis, Brad Gibbons, Dave Palm, and Kris Sparks.

The Flex Program's Technical Assistance and Services Center in Duluth was a helpful partner by sharing its knowledge of current issues and struggles in the hospitals and states. Thank you to Terry Hill and Ann Miller.

The Federal Office of Rural Health Policy was very helpful in providing information, guidance and encouragement: Forrest Calico, Jerry Coopey and Joan Van Nostrand.

Special thanks to the crew at WWAMI who edited and word-processed this document: Denise Lishner and Martha Reeves.

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