Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Pre-COVID-19 and During COVID-19

This study described and compared the differences in the utilization of emergency department (ED) services among rural and urban Medicare Fee-For-Service (FFS) enrollees during 2018-2021. Researchers identified factors associated with differences in ED use, including shifts in volume, primary diagnoses, and admission source, before and since the COVID-19 public health emergency in rural and urban areas.

The purpose of this study was to examine how rural and urban ED outpatient services transitioned and adjusted to the impacts of COVID-19. The study addressed and described the demographic, socioeconomic, and health service characteristics associated with ED service use changes and their relationship to communities that experienced disruptive changes. The study:

• Assessed whether changes in outpatient ED service volume and type across rural and urban areas remained consistent between time periods.
• Described any changes in the array of outpatient ED services sought between the before and since COVID-19 time periods.
• Identified whether observed differences were related to demographic, socioeconomic, and/or geographic setting.
• Developed an understanding of the association between observed differences in ED use that may inform policies and other strategies to improve access to care for future disasters and public health emergencies.

Publications

• Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Before and During Covid
  Policy Brief
  ETSU/NORC Rural Health Research Center
  Date: 01/2025
  The brief examines changes in emergency department (ED) use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries during the COVID-19 pandemic. Key findings included a moderate increase in rural ED use, higher mortality and inpatient admissions, and decreased use among dual-eligible beneficiaries.