Quality assurance issues raised by proposed limited-service rural hospitals

This article explores quality assurance issues that are likely to arise related to limited-service rural hospitals, an institutional alternative to existing rural hospitals. In exploring these issues, we use as an example, the Montana Medical Assistance Facility, a limited-service rural hospital model about to be implemented by the Health Care Financing Administration as a demonstration. While such medical assistance facilities will need to meet licensure and certification requirements, it is not reasonable to expect them to meet regulations that are designed for large hospitals. Also, because of their limited resources, medical assistance facilities will likely need outside help from a larger institution to perform quality assurance activities, particularly peer review activities. A key challenge for the medical assistance facility will be to define the nature of this relationship, while retaining ultimate responsibility for quality of patient care. Assuring quality of care is a particularly important issue for medical assistance facilities since community acceptance and financial viability will depend critically on establishing a record for quality of care that is at least comparable to existing small, rural hospitals.