Care quality at critical access hospitals (CAHs). CAHs provide inpatient care to underserved-primarily rural-areas. Consequently, they receive larger Medicare reimbursements and are exempt from quality improvement requirements. Two recent studies sought to determine whether care quality has suffered as a result of that exemption, as well as other factors such as older, poorer patient populations and limited resources. The first, published in the April 3 JAMA, found that mortality among Medicare patients with acute myocardial infarction, congestive heart failure, and pneumonia was higher at rural CAHs than at non-CAHs. Until 2002 the rates were similar but rose by 1.8% annually at CAHs through 2010. The second study, published online May 1 in JAMA Surgery, shows no difference in mortality following eight common types of surgery at CAHs and non-CAHs. However, surgery costs more at CAHs, ranging from $679 more for cesarean sections to $5,170 more for colorectal cancer resections.