Statement of the problem: To address the issues of fraud and high Medicare margins, the Medicare Payment Advisory Commission (MEDPAC) has recommended changes in reimbursement rates for HH providers. The commission recommended eliminating the market basket update for 2012 and implementing a two-year rebasing of HH rates beginning in 2013. Additionally, in order to reduce costs, the policy change seeks to discourage high intensity HH services such as therapy services and to add a cost-sharing requirement. A considerable fraction of elderly population lives in rural areas. Further, rural elderly have a disproportionate prevalence of illness and limited access to health services. With the current MEDPAC recommendations, it is likely that changes in reimbursement rates would disproportionately affect smaller agencies serving rural populations, thereby reducing access to services among rural beneficiaries.

Project goals: The purpose of this study is to examine the distribution of levels of HH services for joint replacement, stroke, ESRD, and diabetes; the distribution of type of provider for each level of service; and the median charge and payment per Medicare beneficiary. Further, the study will also examine rural-urban differences, if any, in the distribution patterns of HH services and service providers as well as the median service charge across the levels of rurality.

Methods: A cross sectional analysis examining distribution of levels of HH services, the providers of the services, and service charges / payments across the levels of rurality will be conducted using the most recent data obtained from the CMS Research Data Assistance Center (ResDAC). Additionally, county-level data will be drawn from the Area Resource File (ARF). We will create a new dataset by linking the ResDAC and ARF data for the purpose of analysis. Detailed description of the data files and variables of interest are provided under the Research Plan.

Anticipated publications or products: A policy brief will communicate study findings. In addition, we will draft manuscripts for publications in peer-reviewed journals and scholarly presentations for disseminating results in local, regional, and national conferences.

Publications

• Ambulatory Care-Sensitive Condition Hospitalizations Among Medicare Beneficiaries
  Journal Article
  Rural and Minority Health Research Center
  Date: 06/2016
  Examines the relationship between the distribution of primary care physicians and Medicare beneficiaries' ambulatory care-sensitive condition hospitalizations using statistical and spatial analyses.
• Thirty-Day Readmission Rates Among Dual-Eligible Beneficiaries
  Journal Article
  Rural and Minority Health Research Center
  Date: 08/2015
  Examines readmission rates and factors affecting readmission of patients eligible for both Medicare and Medicaid (dual-eligibility).