Post-Acute Care for Rural Medicare Beneficiaries

Lead researcher:
Project funded:
September 2016
Anticipated completion date:
December 2017

Increasingly, attention on Medicare payment policy has turned to post-acute services. Research has shown that discharges to 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 will describe the variation in the volume, mix and financial importance of post-acute services to rural hospitals; identify hospital and community characteristics associated with variation in post-acute services provided by rural hospitals; and determine where rural Medicare beneficiaries receive post-acute services.


  • 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.