Post-Acute Care for Rural Medicare Beneficiaries

Increasingly, attention on Medicare payment policy has turned to post-acute services. Research has shown that discharges to post-acute care (PAC) facilities have increased substantially over the past two decades. Concurrently, hospital lengths of stay progressively decreased, particularly for discharges to PAC facilities. Swing beds use and cost (relative to other skilled nursing services) has received heightened scrutiny, and bundled payment models are seen as a way to address the wide variation in post-acute care. It is not well known how much "exposure" rural hospitals have to these types of policy developments, largely because the role and extent of post-acute care provided in rural settings is not well known. Additionally, these developments may affect patterns of care for rural Medicare beneficiaries, but the magnitude of the effect will depend on the degree to which rural beneficiaries receive post-acute care from their local – or rural – hospital. This project described the variation in the volume, mix and financial importance of post-acute services to rural hospitals; identified hospital and community characteristics associated with variation in post-acute services provided by rural hospitals; and determined where rural Medicare beneficiaries receive post-acute services.

Publications

• A Positive Association Between Hospice Profit Margin and the Rate at Which Patients Are Discharged Before Death
  Journal Article
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 07/2017
  The links between the increasing live discharge rate from hospice and the quality of care is examined.