View Policy Brief

04/2018

As new Medicare payment models are implemented, there is some concern about how it will affect inpatient post-acute care (PAC) in rural areas. Changes in referral patterns and utilization could make maintaining these services financially difficult in rural areas, which could ultimately reduce access to local PAC for rural residents. To learn more, the North Carolina Rural Health Research and Policy Analysis Center uses Medicare claims data (post-acute care discharges) to characterize rural provider market share of inpatient PAC services provided to Medicare beneficiaries.

Key findings: Among rural Medicare beneficiaries who received PAC following discharge from either a rural or an urban acute hospital:

• Rural beneficiaries were more likely to receive skilled nursing services from rural providers (83.4%) than from urban providers (16.6%). However, beneficiaries were more likely to receive inpatient rehabilitation at an urban provider (65.2%) than at a rural provider (34.8%).
• The longest average length of stay for skilled nursing care was in rural skilled nursing facilities (36.4 days) and the shortest was from rural swing beds (10.2 days). There was little difference in the length of stay for rehabilitation care among the types and locations of facilities.
• Discharge from a rural acute hospital was almost always followed by discharge from a rural PAC facility, but discharge of a rural patient from an urban acute hospital was only followed by discharge from a rural PAC facility about half of the time.

North Carolina Rural Health Research and Policy Analysis Center

Alex Schulte, Denise Kirk, Randy Randolph, George Pink

Hospitals and clinics, Long-term care, Medicare, Post-acute care