Utilization and costs of post-acute care for Medicare fee-for-service beneficiaries have grown rapidly over the past decade, particularly for care provided in skilled nursing facilities and by home health agencies. Yet little is known about the current status of post-acute care services for rural Medicare beneficiaries. Describing the type, setting, and focus of care received following acute hospitalization is an important step in gaining knowledge about how rural beneficiaries currently utilize post-acute services and insight into possible effects of changes to Medicare policy in the future. This study reported rates of discharge following acute hospitalization to different types and settings of post-acute care, including home health for routine nursing care, home health for physical and/or occupational therapy, care in a freestanding skilled nursing facility (SNF), SNF care in a subacute unit within a hospital, and SNF care in a swing bed within a hospital as a proxy for referrals for care following acute hospitalization. We also explored trajectories of care across settings beyond the initial setting for post-acute care. We completed a retrospective cohort study of rural Medicare fee-for-service beneficiaries using recent CMS administrative data. We reported rates of discharge from acute hospitalization to home health for routine care, home health for physical and/or occupational therapy, SNF care in a freestanding SNF, SNF care in a subacute unit within a hospital, and SNF care in a swing bed within a hospital. We also described trajectories of care across settings (e.g., hospital to SNF to home health) within 30-, 60-, and 90-day episodes of care.

Publications

• Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned Versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 03/2021
  This policy brief describes trajectories for rural Medicare beneficiaries following hospital discharge, including differences between planned and actual discharge to skilled nursing facilities and home health agencies. More than 40% of beneficiaries for whom home health care was indicated did not receive care from a home health agency.