Where a patient lives has a lot of influence over whether they receive inpatient or home health care after a hospital discharge, according to one recent study. As such, Medicare spending is variable based on urban or rural care settings.
Out of a sample of 1.56 million discharges of urban patients from urban hospitals and rural patients from rural hospitals, just 12.1% were rural patients that were discharged to post-acute care (PAC), including either home health care or a skilled nursing facility (SNF), according to a study published in The American Journal of Managed Care (AJMC). Overall, rural patients receive less PAC after a hospital discharge.
The type of post-acute care can have a significant impact on patient outcomes for certain diagnoses. After stroke or hip replacements, outcomes may be poorer in patients treated at critical access hospitals who use less home health care and more SNF care, according to the study.
However, there may also be limited access for rural patients to quality home health services, the authors of the study speculated.
The study looked at how different diagnoses affected post-acute care outcomes in rural and urban settings. For example, rural patients who received elective joint arthroplasty were 41% less likely to receive PAC of any kind, compared to other diagnoses.
Rural patients were also more likely to receive post-acute care at a SNF if there was a SNF nearby, according to the study.
“Rural patients at rural hospitals received significantly more SNF care and significantly less HHC overall in six of the top 10 most commonly treated diagnoses,” the study reads.
From a cost perspective, nearly 1 million hospitalizations and 30-day PAC episodes for elective joint arthroplasty reaches $15.7 billion annually. Higher use of SNFs in rural areas for these patients is contributing to higher costs. The average cost of a SNF stay is $11,357, compared to $2,720 for a home health care episode, the study says.
Looking ahead at Medicare payment models, these differences are critical in evaluating how to lower cost and improve patient outcomes, researchers said.
Written by Amy Baxter