Advisor(s)

Nancy Borkowski

Committee Member(s)

Amy Landry
Monica Aswani
Philip Cendoma

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Science in Administration Health Services (DSc)

School

School of Health Professions

Department

Health Professions

Abstract

This study investigated the impact of increasing market penetration of Medicare Advantage plans on the financial performance of Critical Access Hospitals (CAHs) in Texas, specifically focusing on days cash on hand (DCOH) and operating margin (OM). With over 20% of Americans relying on CAHs for healthcare, the financial viability of these hospitals is crucial for rural community health. The study analyzed longitudinal data from 72 CAHs in Texas between 2018 to 2023, a period marked by significant changes in the healthcare landscape due to the COVID-19 pandemic. Despite increased enrollment in Medicare Advantage plans rising from 26% to 40%, the regression and sensitivity analyses revealed no statistically significant negative impact on the financial performance of CAHs, contradicting the initial hypotheses. Contributing factors may include federal financial assistance during the pandemic, which temporarily bolstered hospital finances. Additionally, a 10-question survey was sent to 91 Chief Financial Officers of CAHs in Texas. CFO responses indicated administrative challenges stemming from Medicare Advantage plans increasing penetration, including staffing increases to manage credentialing and denial issues. The findings underscore the pressing need for policy reforms to support CAHs, enhance telehealth services, and streamline administrative processes, ensuring the sustainability of healthcare access for rural populations. This research contributes to the understanding of how evolving Medicare Advantage plans affect rural healthcare systems and informs policy recommendations to safeguard the future of critical access hospitals.

ProQuest Publication Number

32245605

ISBN

9798273380004

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