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In Reply Dr Moscovice and colleagues and Dr Westfall and colleagues make several
important points with which we agree. First, regarding misclassification, we suspect that the higher
number of beds than anticipated were due to beds that do not count toward the 25-bed limit, such as
psychiatric, rehabilitation, observation, and labor and delivery beds. If CAHs are matched against
much larger hospitals because of their size classification in the American Heart Association survey,
it certainly would have biased our results. However, it was out of this concern that we adjusted for
number of beds rather than size category, and unless CAHs were systematically overreporting their
beds in a way that is different from non-CAHs, we suspect any bias is likely to be small.
Joynt KE, Orav JE, Jha AK. Mortality Trends in Critical Access Hospitals—In
Reply. JAMA. 2013;310(4):430. doi:10.1001/jama.2013.8745