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What Characteristics Influence Whether Rural Beneficiaries Receiving Care From Urban Hospitals Return Home for Skilled Nursing Care?
Author(s) -
Hoffman Abby F.,
Pink George H.,
Kirk Denise A.,
Randolph Randy K.,
Holmes George M.
Publication year - 2019
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/jrh.12365
Subject(s) - beneficiary , acute care , odds , medicine , logistic regression , population , prospective payment system , skilled nursing facility , payment , nursing , health care , family medicine , business , environmental health , finance , economic growth , economics
Purpose Skilled nursing care (SNC) provides Medicare beneficiaries short‐term rehabilitation from an acute event. The purpose of this study is to assess beneficiary, market, and hospital factors associated with beneficiaries receiving care near home. Methods The population includes Medicare beneficiaries who live in a rural area and received acute care from an urban facility in 2013. “Near home” was defined 3 different ways based on distances from the beneficiary's home to the nearest source of SNC. Results include unadjusted means and odds ratios from logistic regression. Findings About 69% of rural beneficiaries receiving acute care in an urban location returned near home for SNC. Beneficiaries returning home were white (odds ratio [OR] black: 0.69; other race: 0.79); male (OR: 1.07); older (OR age 85+ [vs 65‐69]: 1.14); farther from SNC (OR: 1.01 per mile); closer to acute care (OR: 0.28, logged miles); and received acute care from hospitals that did not own a skilled nursing facility (owned OR: 0.77) and hospitals with: no swing bed (swing bed OR: 0.47), high case mix (OR: 3.04), and nonprofit status (for‐profit OR: 0.85). Results varied somewhat across definitions of “near home.” Conclusions Rural Medicare beneficiaries who received acute care far from home were more likely to receive SNC far from home. Because Medicare beneficiaries have the choice of where to receive SNC, policy makers may consider ensuring that new payment models do not incentivize provision of SNC away from home.