More than one-third of Medicare beneficiaries are discharged to post-acute care following inpatient hospitalization, with initial post-acute care services provided by skilled nursing facilities and home health agencies about 80% of the time. Post-acute care is also a key driver of geographic variation in Medicare spending.

Due to wide geographic variation in utilization, costs, and quality of post-acute care for Medicare beneficiaries, Centers for Medicare & Medicaid Services is implementing value-based purchasing programs for skilled nursing facilities and home health agencies to incentivize high quality, efficient care. The skilled nursing facility value-based purchasing program started in 2017 and includes all Medicare-certified skilled nursing facilities across the country. The home health value-based purchasing demonstration started in 2016 and includes all Medicare-certified home health agencies in nine states. A nationwide home health value-based purchasing program is slated to launch by 2022. Both value-based purchasing programs include rural providers. Yet little is known about quality of care specifically among rural post-acute care providers and with respect to urban providers. Since rural post-acute care providers face unique challenges in delivering care and rural post-acute patients are often sicker and at higher risk for poor outcomes, rural providers may be at greater risk for penalties under value-based purchasing programs. Rural post-acute care providers that have Medicare payments substantially decreased for poor performance may not have the resources necessary to implement quality improvement initiatives to avoid further penalties. While high-quality care must remain a key goal for all providers, reductions in payments may disproportionately impact some rural providers, which in turn may exacerbate disparities for rural beneficiaries.

Publications

• Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 02/2022
  This policy brief describes the quality of home health agencies (HHAs) by rural-serving status. While quality of patient care star ratings were not associated with rural-serving status, rural HHAs and urban HHAs that serve rural patients had higher patient experience star ratings than urban HHAs that do not serve rural patients.
• Quality of Skilled Nursing Facilities Serving Rural Medicare Beneficiaries
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 02/2022
  This policy brief describes the quality of skilled nursing facilities (SNFs) by rural-serving status. While overall star ratings and staffing star ratings were not associated with rural-serving status, rural SNFs and urban SNFs that serve rural patients had lower quality star ratings compared to urban SNFs that do not serve rural patients.