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

• The Financial Importance of Medicare Post-Acute and Hospice Care to Rural Hospitals
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 07/2017
  This brief describes Medicare post-acute and hospice care provided by hospitals in rural areas by characterizing the variation in the number of rural hospitals that provide PAC and hospice care, the average amount of Medicare revenue rural hospitals receive for these services, and the financial importance of PAC and hospice care to rural hospitals.
• Market Characteristics Associated With Rural Hospitals' Provision of Post-Acute Care
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 04/2018
  This brief uses data from Medicare cost reports, the Provider of Services File, and the U.S. Department of Agriculture to provide a window into current hospital-based post-acute care offerings by summarizing both hospital- and market-level factors that are associated with rural hospitals that provided post-acute care between 2012 and 2015.
• 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.
• Rural and Urban Provider Market Share of Inpatient Post-Acute Care Services Provided to Rural Medicare Beneficiaries
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 04/2018
  The purpose of this brief is to characterize rural providers' market share of inpatient post-acute care services provided to rural Medicare beneficiaries.