Frequently Asked Questions
If your question is not answered below, please contact us.
How do I gain access to the CAHMPAS system?
The community and quality data in CAHMPAS are available to the public and a login is not required.
The financial data in CAHMPAS is password protected for the security of the hospitals. The only approved users for the financial portion of CAHMPAS are CAH CEOs, CFOs, State Flex Coordinators and officials from the State Offices of Rural Health. If you are one of these users and need access to your login information, email us at email@example.com and provide your name, position, organization/hospital, and city/state. If you are not one of these users, we appreciate your interest in the financial data on CAHMPAS but unfortunately cannot provide you with access to this system.
Whom do I contact if I have forgotten my CAHMPAS username or password?
You can contact us at firstname.lastname@example.org.
I am new to CAHMPAS and looking for materials to help with understanding the system. What resources do you provide?
Does CAHMPAS include data for rural hospitals that are not CAHs?
No, CAHMPAS is currently limited to CAHs.
What is the source of the data in CAHMPAS?
Quality data are calculated by the Flex Monitoring Team using data from CMS. The financial indicators are calculated by the Flex Monitoring Team using data from hospitals’ Medicare cost reports. The market indicators are calculated by the Flex Monitoring Team using data from Nielsen Claritas. Community data come from the American Hospital Association (AHA) Annual Survey Database, County Health Rankings, and data from Worksheet S-10 of the Medicare Hospital Cost Reports from CMS.
When are data updated in CAHMPAS?
Quality and Community data are updated annually in the spring, typically no later than March 31. Data on the twenty-three financial indicators will be updated on a quarterly basis, but some hospitals’ data will be missing in early quarters as their cost reports may not have been submitted by the time the data are released. The financial distress index will continue to be updated annually by March 31.
What if I believe there is a data error in CAHMPAS?
The financial data in CAHMPAS are derived from the Medicare cost reports. If this data looks incorrect, users should first check with the individual or firm that completed the Medicare cost report. If there still appears to be an error in CAHMPAS or an error in the quality or community data, contact the Flex Monitoring Team at email@example.com.
Does the Flex Monitoring Team maintain an archive of CAH location data for previous years?
Though the graph works in CAHMPAS, my graph does not download properly as an image. What should I do?
You can troubleshoot any image download problems by selecting a different application with which to open your file. When prompted to “Open the file with…”, try selecting a PDF viewer or an internet browser as your application. When the file opens, you can then copy and paste the graph elsewhere or print it from that application. If you have further issues with the graph download function, please send us an email at firstname.lastname@example.org.
Does the Flex Monitoring Team maintain a list of CAHs that might soon lose CAH designation?
We do not currently maintain a list of this type.
Does the Flex Monitoring Team maintain a list of hospitals that have closed?
No, but a list of all rural hospital closures is available at the website of the North Carolina Rural Health Research Program. You may access this website by clicking here.
Does the Flex Monitoring Team maintain a database for non-CAH hospitals?
We do not maintain a database of that type at this time.
Are the community indicators available for individual CAHs?
No. The community data are aggregated at the county, state, and national level. Community characteristics include various socioeconomic factors, health outcomes, health behaviors, provider supply and access to care, and environmental issues. CAH service mix indicators include wellness and prevention services, primary care, obstetrics, dentistry, behavioral health, emergency medical services, and long-term services and supports. Users can also compare the cost of charity care, bad debt, and uncompensated care among CAHs.
How are the community indicators structured? Are all indicators available at the county, state, and national level?
For Part 1:
Community Characteristics, County Health Rankings and Roadmaps data are available for all counties in states with Flex Programs and include state and national comparisons. Most national estimates represent “top U.S. performers” defined as “the value for which only 10% of counties in the country are doing better, i.e., the 90th percentile or 10th percentile, depending on whether the measure is framed positively (e.g., high school graduation) or negatively (e.g., adult smoking).” The estimates for “% of population below 18 years of age,” “% of population age 65 and older,” and “infant mortality” are overall national rates rather than “top U.S. performer” rates.
For Part 2:
CAH Service Mix, American Hospital Association survey data are available at the state and national levels and reflect only those CAHs that reported valid survey responses.
For Part 3:
CAH Charity Care and Bad Debt, data are available at the state and national level and reflect only those CAHs that reported valid dollar amounts on Medicare Hospital Cost Report Form 2552-10 Worksheet S-10.
Are County Health Rankings data comparable across state lines?
The County Health Rankings gather data from around the nation that is comparable between counties, within states. For most measures, county data is also comparable across state lines. However, for a few measures, some caution must be exercised when making comparisons between counties in different states:
- Adult obesity: The model used to construct these estimates includes state-level effects that may overestimate differences in border counties.
- Food environment index: The food insecurity models include state-level effects that may overestimate differences in border counties.
- Physical inactivity: The model used to construct these estimates includes state-level effects that may overestimate differences in border counties.
- Sexually transmitted infections: Chlamydia screening patterns may vary between states and health care systems. Differences in rates may reflect differences in these screening patterns, rather than differences in the underlying rates of disease.
- High school graduation: High school graduation data has been gathered from state-specific data sources. While many changes have been instituted to ensure that graduation rates are comparable between states, we do not recommend comparing these estimates across state lines. Cohort and graduate definitions, and suppression criteria vary from state to state.
- Violent crime: Violent crime rates are dependent on the reporting practices of both residents and law enforcement offices in states and jurisdictions. These practices can vary by both state and jurisdiction, so caution should always be observed when comparing crime rates.
How are the charity care, bad debt, and uncompensated care indicators calculated?
The charity care, bad debt, and uncompensated care data are extracted from Medicare Hospital Cost Report form 2552-10, Worksheet S-10 line 23, column 3 (charity care); line 29 (non-Medicare and non-reimbursable Medicare bad debt expense); and line 30 (uncompensated care which includes both the costs of charity care and the non-Medicare and non-reimbursable Medicare bad debt expense). Hospital adjusted revenue data are extracted from Worksheet G-3 line 3 (net patient revenues). The CAHMPAS indicators are calculated as a percent of adjusted revenue by dividing the reported dollar amount for each item by the reported total adjusted revenue for each hospital. County, state, and national means are calculated and presented for purposes of comparison.
For further information and suggested citations:
American Hospital Association Annual Survey Database. American Hospital Association Annual Survey. Available at: https://www.ahadataviewer.com/additional-data-products/AHA-Survey/
County Health Rankings and Roadmaps. University of Wisconsin Population Health Institute. County Health Rankings. Available at: http://www.countyhealthrankings.org/explore-health-rankings/rankings-data-documentation
Medicare Hospital Cost Reports. Centers for Medicare and Medicaid Services. Hospital Form 2552-10 Cost Report Data files. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Hospital-2010-form.html
Financial FAQs can be found within the Financial data portal.
Are quality data available for individual CAHs?
The quality measures are currently aggregated to the state level by the Flex Monitoring Team and are not available through CAHMPAS for individual CAHs. Public reporting of these data is not allowable due to low volume at the individual CAH level because of CMS data suppression guidelines. Individual CAH data was previously available through the password protected CAHMPAS portal, but these data are no longer available.
Fewer CAHs in my state are listed as reporting measures than actually are, who should I contact about this?
Please contact us at email@example.com with questions about data reporting or performance.
Why does the data on CAHMPAS look different from other quality data on the same measures?
The data on CAHMPAS come from hospitals with Memorandums of Understanding (MOUs) with FORHP for the MBQIP program (2019-on), or from Hospital Compare with suppressed data not available on the Hospital Compare website (2016-2018). Data may vary from other publicly available sources. Please direct any questions to firstname.lastname@example.org.
What is the difference between Hospital Compare Data and MBQIP Data?
Hospital Compare is a Medicare website that contains data for hospitals on various quality measures. Several Hospital Compare measures are also measures for the Medicare Beneficiary Quality Improvement Project (MBQIP), a quality improvement activity in the Flex program. Most CAHs report data for these identical measures to both Hospital Compare and MBQIP. However, some CAHs only report data to one of these programs. Data in CAHMPAS come from Hospital Compare, which means that the data in CAHMPAS may differ from MBQIP reports because they only come from Hospital Compare. Starting in 2019, CAHMPAS only includes MBQIP data from CAHs reporting with signed MBQIP MOUs.
Which measures were used to determine “State Rankings of CAH Reporting Rates for Inpatient Quality Measures” for each year?
Inpatient rankings include the following measures:
- 2020 – HCP/IMM-3; ABX; CLABSI; CAUTI; CDI; MRSA; SSI:C; SSI:H
- 2019 – HCP/IMM-3; ABX; ED-2b; CLABSI; CAUTI; CDI; MRSA; SSI:C; SSI:H
- 2018 – HCP/IMM-3; PC-01; VTE-6; ABX; ED-1b; ED-2b
- 2017 – IMM-2; HCP/IMM-3; PC-01; VTE-6; ED-1b; ED-2b
- 2016 – IMM-2; HCP/IMM-3; PC-01; STK-4; VTE-5; VTE-6; ED-1b; ED-2b
Which measures were used to determine “State Rankings of CAH Reporting Rates for Outpatient Quality Measures” for each year?
Outpatient rankings include the following measures:
- 2020 – OP-2; OP-3b; OP-18b; OP-22
- 2019 – OP-2; OP-3b; OP-18b; OP-22
- 2018 – OP-2; OP-3b; OP-5; OP-18b; OP-22; OP-23; OP-29; OP-30
- 2017 – OP-1; OP-2; OP-3b; OP-4; OP-5; OP-18b; OP-20; OP-21; OP-22; OP-23; OP-29; OP-30
- 2016 – OP-1; OP-2; OP-3b; OP-4; OP-5; OP-18b; OP-20; OP-21; OP-22; OP-23; OP-29; OP-30
What are population and sampling data?
Population and sampling data are data submitted by hospitals to CMS at the time of their data submission outlining the population data and any applicable sampling data for data measures. These data allow for the determination of whether CAHs submitted a zero value due to non-reporting or lack of an applicable population for a given measure. Beginning in Q4 2020, population and sampling data became available for measures OP-2, OP-3b, and OP-18b, whereas previously it was not possible to separate those CAHs so they were all treated as non-reporting. This change may affect the number of CAHs reporting for those measures and/or Outpatient reporting totals.