This study will examine trends in the distribution of skilled nursing facility (SNF) services in rural hospitals during a period of dramatic change in Medicare reimbursement, most notably the transition from cost-based reimbursement to SNF prospective payment system (PPS). The supply and organization of skilled nursing care have been shown to be very sensitive to changes in Medicare regulations, as the majority of patients receiving SNF services following a hospitalization are elderly or disabled, and the majority of such services are covered by Medicare. Using national licensure files for information on supply, and Medicare's hospital and nursing facility cost reports for information on costs and utilization, we propose to analyze changes in the role of rural hospitals in providing SNF services as they respond to the new reimbursement environment.

The primary study objectives are to document changes in rural hospitals' skilled nursing care delivery, and to identify rural hospitals' responses to changes in skilled nursing payments. While many of the measures described above are tracked by CMS and are available at the national level, they have not been documented specifically for rural providers, or at the detailed level of rural-urban continuum codes. These questions, therefore, will be addressed with extensive descriptive statistics. Multivariate models will be constructed to identify geographic and organizational factors associated with changes in hospital SNF participation over time, and to investigate differences between PPS and CAH providers. Findings will be presented in a working paper describing all parts of the study, plus two to three more narrowly focused findings briefs on specific topics.

Publications

• 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.
• 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.