Post-acute care
Research Products & Journal Articles
Browse the full list of research publications on this topic completed by the Rural Health Research Centers.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2024
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Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2024
This brief examines the estimated impact of three Medicare payment policy changes on home health agency (HHA) reimbursement by rural-serving status, geographic location, and select HHA characteristics. -
Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas
Journal Article
RUPRI Center for Rural Health Policy Analysis
Date: 01/2024
Nursing home closures have raised concerns about access to post-acute care (PAC) and long-term care (LTC) services. In this study, researchers estimate the additional distance rural residents had to travel to access PAC and LTC services because of nursing home closures.
2023
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Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas (journal article)
Journal Article
University of Minnesota Rural Health Research Center
Date: 02/2023
In this manuscript, the research team used data from the 2021 Occupational Employment and Wage Statistics dataset to calculate the ratio of direct care workers relative to the population of older adults (ages 65+) across rural and urban areas in the US.
2022
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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.
2021
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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.
2020
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Variation in Use of Home Health Care Among Fee-for-Service Medicare Beneficiaries by Rural-Urban Status and Geographic Region: Assessing the Potential for Unmet Need
Policy Brief
WWAMI Rural Health Research Center
Date: 02/2020
This study describes use of home healthcare by rural-urban status and geographic region. Findings suggest geographic region drives variation more than rural-urban status. Unmet need may be highest in the most remote rural counties and rural counties within the West North Central, East North Central, Mountain, and Pacific Census Divisions.
2019
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Differences in Care Processes Between Community-Entry Versus Post-Acute Home Health for Rural Medicare Beneficiaries
Policy Brief
WWAMI Rural Health Research Center
Date: 04/2019
This study describes home healthcare processes for rural Medicare beneficiaries who are admitted from the community (community-entry) versus those who are admitted following an inpatient stay (post-acute). Care processes include timely initiation of care, length of stay, and services provided (e.g., physical therapy, medical social work).
2018
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Different Populations Served by the Medicare Home Health Benefit: Comparison of Post-Acute Versus Community-Entry Home Health in Rural Areas
Policy Brief
WWAMI Rural Health Research Center
Date: 07/2018
This study describes differences between rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) and those who are admitted to home health following an inpatient stay (post-acute) in terms of their clinical and non-clinical characteristics as well as the communities in which they live. -
Service Provision and Quality Outcomes in Home Health for Rural Medicare Beneficiaries at High Risk for Unplanned Care
Journal Article
WWAMI Rural Health Research Center
Date: 06/2018
This study examined service provision and quality outcomes among rural Medicare beneficiaries who used home health from 2011-2013 and were at high risk for unplanned care. More skilled nursing visits and visits by more types of providers were associated with higher hospital readmission and emergency department use and lower community discharge. -
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. -
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.
2017
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Rural Long-Term Services and Supports: A Primer
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 11/2017
This paper provides policymakers and other interested stakeholders a primer on the fundamentals of the rural LTSS system, rural access to and use of LTSS, and the opportunities and limitations of current federal and state LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system. -
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.
2015
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Developmental Strategies and Challenges for Rural Accountable Care Organizations
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2015
This brief offers insights into the initial strategic decisions and challenges of four accountable care organizations (ACOs) with rural presences. These ACOs were formed as a step toward a value-driven rural delivery system. While several challenges need to be addressed, these insights can inform development of other rural ACOs.
2012
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Why Use Swing Beds? Conversations With Hospital Administrators and Staff (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 04/2012
In this study, we interview hospital administrators and staff about the use of swing beds. Topics include the role of swing beds in patient care, swing bed volume and financial considerations, swing beds in the context of all community post-acute skilled care, and swing beds as a benefit for community residents. -
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia
Policy Brief
Upper Midwest Rural Health Research Center
Date: 03/2012
This brief explores the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban patients, and time to follow-up care. These factors were examined in a large population of Medicare patients with hospital stays for congestive heart failure or bacterial pneumonia. -
Effect of Outpatient Visits and Discharge Destination on Potentially Preventable Readmissions for Congestive Heart Failure and Bacterial Pneumonia (Final Report)
Upper Midwest Rural Health Research Center
Date: 03/2012
This study explored the relationship between potentially preventable readmissions and use of outpatient follow-up care, discharge destination, rural versus urban residence of the patient, and time to follow-up care.
2011
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Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Policy Brief
Upper Midwest Rural Health Research Center
Date: 09/2011
This report assesses the challenges and consequences for rural providers and patients of implementing bundled payments for acute and post-acute care episodes; explores impacts on care quality under a facility-physician bundled payment system; and describes potential modifications to bundling proposals and steps that could address rural issues. -
Trends in Skilled Nursing Facility and Swing Bed Use in Rural Areas Following the Medicare Modernization Act of 2003 (Findings Brief)
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2011
This findings brief looks at whether the availability of post-acute skilled care stabilized and how and where is it being provided today now that the reimbursement policy changes begun in the late 1990s have been fully implemented.
2010
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Alternatives to the Outpatient Prospective Payment System: Assessing the Impact on Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 04/2010
The purpose of this policy brief is to explore alternatives to the outpatient prospective system and how these options would affect rural hospitals.
2009
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Rural Issues Related to Bundled Payments for Acute Care Episodes
Policy Brief
Upper Midwest Rural Health Research Center
Date: 06/2009
Bundling Medicare payments has been proposed as a way of encouraging providers to find innovative, cost-reducing strategies to provide better coordinated care. This brief describes challenges to implementing bundled payments in rural settings and discusses potential contracting and reimbursement strategies to address the challenges.
2006
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Trends Over Time in the Provision of Skilled Nursing Care in Critical Access Hospitals
North Carolina Rural Health Research and Policy Analysis Center
Date: 02/2006
This findings brief examines trends in the delivery of skilled nursing facility services in both hospital-based units and swing beds during a period of dramatic change in Medicare payments for post-acute care, focusing on critical access hospitals.
2005
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Trends in Skilled Nursing and Swing-Bed Use in Rural Areas, 1996-2003
North Carolina Rural Health Research and Policy Analysis Center
Date: 12/2005
This paper examines trends in the delivery of skilled nursing facility (SNF) services in rural areas during a time of dramatic change in Medicare payments for acute and post-acute care. It focuses on the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment. -
Patterns of Post-Acute Utilization in Rural and Urban Communities: Home Health, Skilled Nursing, and Inpatient Medical Rehabilitation
NORC Walsh Center for Rural Health Analysis
Date: 03/2005
This report describes rural Medicare beneficiaries' patterns of post-acute utilization of home health services, skilled nursing facilities, and inpatient rehabilitation facilities. -
Rural Implications of Medicare's Post-Acute-Care Transfer Payment Policy
Journal Article
NORC Walsh Center for Rural Health Analysis
Date: 2005
Examines how the initial policy change affected rural and urban hospitals and investigates the likely impact of the FY2004 expansion and other possible future expansions. The authors conclude that rural hospitals are not disproportionately harmed by the post-acute-care transfer policy.
2004
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Exploring the Impact of Medicare's Post-Acute Care Transfer Payment Policy on Rural Hospitals
NORC Walsh Center for Rural Health Analysis
Date: 07/2004
This policy analysis brief describes a change in Medicare post-acute transfer payment policy and its impact on rural and urban hospitals. It includes data on the financial impact and hospital discharge behavior before and after the change. -
Rural Implications of Medicare's Post-Acute Care Transfer Payment Policy
NORC Walsh Center for Rural Health Analysis
Date: 06/2004
This study examines the behavioral and financial impacts of the initial 10-DRG policy and projects the likely financial impact of extending the policy to cover additional DRGs or discharges to swing beds.
2002
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Rural Dimensions of Medicare Reimbursement for Inpatient and Outpatient Institutional and Physician Services
NORC Walsh Center for Rural Health Analysis
Date: 12/2002
This report examines major Medicare payment policies from the rural perspective and summarizes major payment policies with explicit rural dimensions that directly affect physicians and hospitals. It looks at whether direct rural impacts are consistent with legislative and regulatory intentions.
2001
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Quality of Medicare Outpatient Claims Data and Its Implications for Rural Outpatient Payment Policy
NORC Walsh Center for Rural Health Analysis
Date: 12/2001
This study analyzes Medicare outpatient claims to see if the relatively poor quality of small rural hospitals' claims data have amplified the negative effects of the new payment system on small hospitals. -
Improving the Quality of Outpatient Care for Older Patients With Diabetes: Lessons From a Comparison of Rural and Urban Communities
Journal Article
WWAMI Rural Health Research Center
Date: 08/2001
Compares the quality of diabetic care received by patients in rural and urban communities in Washington State. Concludes that large rural towns may provide the best conditions for high-quality care-growing communities that serve as regional referral centers and have an adequate, but not excessive, supply of generalist and specialist physicians.