Department of Economics and Health Care Management, Labovitz School of Business and Management, University of Minnesota, Duluth, Minnesota, USA.
Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island, USA.
J Rural Health. 2023 Jun;39(3):604-610. doi: 10.1111/jrh.12725. Epub 2022 Nov 6.
Home health agencies delivering care in rural counties face unique challenges when providing care to older adults; long travel times between each visit can limit the number of patients seen each day. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries without evaluating the policy's impact on patient outcomes.
Using 100% Medicare data on postacute HH episodes from 2007 to 2014, we estimated the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010.
Our sample included 5.6 million postacute HH episodes (18% rural). In the preperiod, the 30- and 60-day rehospitalization rates for urban HH episodes were 11.30% and 18.23% compared to 11.38% and 18.39% for rural HH episodes. After 2010, 30- and 60-day rehospitalization rates declined, 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points (P = .005) and 0.57 percentage points (P < .001) for 30- and 60-day rehospitalization, respectively.
Increasing payments resulted in a statistically significant reduction in rehospitalizations for rural postacute HH episodes. The add-on payment is set to sunset in 2022 and its impact on access and quality to HH for rural older adults should be reconsidered.
在为农村地区的老年人提供护理时，提供家庭保健服务的机构面临着独特的挑战；每次就诊之间的长途旅行时间限制了每天可看的患者数量。2010 年，医疗保险开始向为农村受益人提供服务的家庭保健（HH）提供者支付 3%的额外费用，而没有评估该政策对患者结果的影响。
利用 2007 年至 2014 年的 100%医疗保险急性后期 HH 发作数据，我们使用差异分析估计了更高的支付对受益人结果的影响，将 2010 年前后农村和城市急性后期 HH 发作之间的再入院进行比较。
我们的样本包括 560 万例急性后期 HH 发作（18%为农村）。在前期，城市 HH 发作的 30 天和 60 天再入院率分别为 11.30%和 18.23%，而农村 HH 发作的再入院率分别为 11.38%和 18.39%。2010 年后，城市 HH 发作的 30 天和 60 天再入院率分别下降至 10.08%和 16.49%，农村 HH 发作的再入院率分别下降至 9.87%和 16.08%。30 天和 60 天再入院的差值估计分别为 0.29 个百分点（P =.005）和 0.57 个百分点（P <.001）。
增加付款导致农村急性后期 HH 发作的再入院率出现了具有统计学意义的下降。附加付款将于 2022 年到期，应重新考虑其对农村老年人获得家庭保健服务和质量的影响。
