Market Characteristics Associated With Rural Hospitals' Provision of Post-Acute Care


Post-acute care (PAC) in rural hospitals, particularly Critical Access Hospitals (CAHs), represents an important source of PAC access in rural areas. In addition, a rural hospital's financial health often depends on providing services that meet local need. Over time, some changes in Medicare payment policies have adversely affected rural providers. For example, when the Balanced Budget Act of 1997 created the home health prospective payment system, a significant number of rural hospitals ended their home health services. With the increased use of more recent payment models such as Accountable Care Organizations, bundled payments, and value-based arrangements, hospitals' decision-making around PAC may be changing once again. This brief uses data from Medicare cost reports, the Provider of Services File (POS), and the United States Department of Agriculture (USDA) 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. Between 2012 and 2015, most rural hospitals provided PAC, and CAHs were more likely than PPS facilities to offer the service. PAC provision varies regionally, with the highest proportion of rural facilities offering PAC in the Northeast and the lowest proportion offering PAC in the West. Facilities that offer PAC are more often located in remote areas (those with a FAR code) and in areas with fewer SNF beds. Facilities that do not offer PAC are less often located in remote areas and are located in areas that have more SNF beds.

North Carolina Rural Health Research and Policy Analysis Center
Abby Hoffman, Randy Randolph, Alex Schulte, George Pink