Identifying Characteristics Associated With Rural and Urban Medicare Beneficiaries Bypassing Local Skilled Nursing Facilities for Post-Acute Care

Skilled nursing facilities (SNFs) provide short-term nursing and rehabilitation services to help bridge the transition from hospital to home for Medicare beneficiaries recovering from illness or injury. Although the majority of beneficiaries live in counties with access to at least three SNFs, 10.1 percent of nonmetropolitan versus 3.7 percent of metropolitan counties lack SNFs, and closures over the past decade have disproportionately impacted nonmetropolitan counties. In 2018, over one-fifth of urban SNFs had a patient population consisting of 10 percent or more rural beneficiaries and four-fifths of urban SNFs served at least one rural beneficiary.

Little is known about the degree to which rural and urban Medicare beneficiaries are receiving care outside of their local communities and what factors are associated with bypassing local SNFs for post-acute care. Given the impact of COVID-19 and workforce challenges coupled with recent changes in Medicare payment policy for SNFs, it is essential to understand post-acute care bypass in a more contemporary context. The purpose of this project is to provide a current and comprehensive examination of post-acute care bypass for Medicare beneficiaries nationally and by rural-urban status, and examine which patient, provider, and community characteristics are associated with bypass of local SNFs. Findings will provide critical information to propose guidance on discharge practices to SNFs and help inform policies to encourage SNFs to operate in rural communities.