Transfer visits had longer reported ED medians at rural emergency hospitals

In every rural emergency hospital that reported both measures, the facility's median emergency-department duration was longer for transfer visits than for all visits in the latest data from the Centers for Medicare & Medicaid Services.

The paired comparison covers 24 facilities. Their median within-facility difference was 127.5 minutes. Transfer-visit facility medians had an unweighted median of 242.5 minutes in that paired group, compared with 111.5 minutes for the same facilities' all-visit medians.

These are comparisons of reported facility-level medians, not individual patient records or a national patient-level average. The measures describe total emergency-department duration before leaving the visit—or before transfer—not an isolated waiting period or the time spent arranging a transfer.

Quick read

• The CMS release contains 43 rural emergency hospitals in 18 states, with one unique row for each of four expected measures per facility.
• All 24 facilities reporting both measures had a higher transfer-visit ED median than all-visit ED median; the median within-facility difference was 127.5 minutes.
• Excluding shorter-reporting-period records left 17 paired facilities and produced a similar 128-minute median difference.
• Data availability falls sharply for narrower groups: 24 facilities reported a transfer median and only 13 reported a psychiatric or mental-health visit median.

A new hospital model with a narrow mission

Congress created the rural emergency hospital designation as an alternative for certain small rural hospitals that might otherwise close. The designation became effective in 2023. REHs provide emergency, observation and other outpatient services; patients generally stay less than 24 hours. They do not operate like full-service inpatient hospitals.

That model makes transfer-related ED duration important to monitor. A patient who needs inpatient or specialty care beyond the facility's scope must move to another hospital. The CMS transfer measure runs across the full emergency-department interval before transfer. It can include evaluation, treatment and clinical stabilization as well as finding an accepting facility and arranging transportation. The public file does not isolate any one component, so it cannot support a claim about “waiting time” or transfer-arrangement time alone.

What the numbers show

The August 2026 CMS release covers October 1, 2024 through September 30, 2025. It contains 172 rows: four measures for each of 43 facilities across 18 states.

Thirty-nine facilities reported numeric results for the broad all-visit measure. The unweighted median of those facility medians was 110 minutes, with reported facility medians ranging from 55 to 157 minutes. The companion measure excluding transfers and psychiatric or mental-health visits had a 100-minute median across 39 facilities.

Transfer results were available for 24 facilities. Their unweighted median was 242.5 minutes, with facility medians ranging from 189 to 478 minutes. Among those same 24 facilities, the all-visit median was 111.5 minutes. Every facility's transfer-visit median exceeded its own all-visit median, and the median of the 24 within-facility differences was 127.5 minutes.

Psychiatric or mental-health visit results were available for just 13 facilities; the unweighted median among those facilities was 180 minutes. Because that reporting group differs from the transfer and all-visit groups, those aggregate medians should not be treated as a like-for-like facility comparison.

These figures are deliberately presented as medians of facility medians. We did not combine patient counts to manufacture a national average because the file publishes facility-level summary measures rather than patient-level observations. Each reporting facility receives equal weight in this analysis.

Missing values are part of the story

The narrower the patient group, the thinner the public picture becomes. Thirty of 43 facilities lacked a numeric psychiatric or mental-health result, while 19 lacked a numeric transfer result. CMS footnotes show that unavailable results often reflect too few cases or no cases meeting the measure criteria.

Seventeen facilities carried a footnote indicating a shorter reporting period than required. Excluding all such records left 17 facilities with both an all-visit and transfer result. The paired pattern remained: transfer medians were higher at all 17 facilities, the paired all-visit and transfer medians were 110 and 240 minutes, and the median within-facility difference was 128 minutes. The sensitivity result is close to the full paired result, but it does not remove other differences in facility case mix or reporting.

The missingness is not evidence that a facility failed to deliver care, refused transfers or had zero behavioral-health visits. It is a public-reporting constraint. Treating “Not Available” as zero would be a serious error.

What this data can—and cannot—answer

The file can show the distribution of reported facility medians, compare measures within facilities, and show how availability changes by measure. It cannot explain why the total ED duration before transfer was longer, establish that a hospital caused a delay, separate clinical-care time from transfer-arrangement time, or measure travel after departure.

It also does not answer the broader access question by itself. A rural emergency hospital may preserve round-the-clock emergency and outpatient capacity in a community that lost inpatient services. Evaluating that tradeoff requires travel-time, destination-capacity, clinical-outcome and community data that are not present here.

For policymakers and hospital leaders, the next useful step is to track the same measures across releases as more facilities and longer reporting histories become available. If transfer medians remain elevated, local analysis should separate the time needed for clinical care from the time spent locating a bed and arranging transport.

Methodology and limitations

MedDataUSA retrieved the CMS Provider Data Catalog API response for dataset 97xg-v3wv on October 7, 2026. We verified that all 172 rows form unique facility/measure pairs and that each of the 43 facilities has each of the four expected measure IDs exactly once. Numeric scores were converted to minutes; “Not Available” values were excluded.

For each measure, we calculated an unweighted median across reported facility medians. The primary comparison retained only facilities with numeric results for both the all-visit and transfer measures, then calculated the difference within each facility. The sensitivity analysis repeated that paired comparison after excluding records marked with CMS footnote 3 for a shorter reporting period. Footnote codes were validated against the CMS Footnote Crosswalk.

No risk adjustment, patient weighting or significance test was applied. The results do not rank facilities, represent patient-level experience, isolate waiting or transfer-arrangement time, measure travel after departure or establish causation. The number of reporting facilities differs by measure.

Sources

• Centers for Medicare & Medicaid Services, Rural Emergency Hospital Timely and Effective Care — Hospital, released August 13, 2026.
• CMS, Footnote Crosswalk.
• CMS, Rural Emergency Hospitals fact sheet.
• Reproducible calculation and source snapshots: the preserved internal analysis package.