The Impact of the Home Health Rural Add-on Payment on Medicare Beneficiary Access and Outcomes

Loomer, Lacey

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Year:: 2020
Contributor:: Loomer, Lacey (creator); Mor, Vincent (Advisor); Rahman, Momotazur (Reader); Gozalo, Pedro (Reader); Mroz, Tracy (Reader); Brown University. Department of Health Services, Policy and Practice (sponsor)
Genre:: theses
Subject:: Medicare; Rural health services; Home care services
Extent:: v, 62 p.

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Abstract:: Rural Americans are disproportionately older, impoverished and burdened by chronic conditions compared to their urban counterparts. In order to bolster access to health care, the Centers for Medicare and Medicaid Services has implemented several policies that increase payments to providers serving rural Medicare beneficiaries. One policy known as the home health rural add-on payment, enacted in April 2010 as part of the Patient Protection and Affordable Care Act, pays home health episodes for rural beneficiaries 3% higher than episodes for urban beneficiaries. The purpose of this work was to examine the effects of the home health rural add-on payment on Medicare beneficiary access and outcomes. I used administrative data spanning before and after the policy was implemented to examine its effect on access and outcomes. In Chapter 1, using a difference-in-difference framework, I examined the proportion of Medicare beneficiaries going to home health after being hospitalized compared to home without home health and going to a nursing home, before and after the policy between urban and rural areas. I also assessed the number of home health visits that were received among the cohort that received home health. I found that higher payments for rural home health episodes increased the number of home health users but decreased home health visits per home health user. In Chapter 2, I examined how the rural add-on payment influenced 30- and 60-day rehospitalization rates among rural and urban beneficiaries with post-acute home health, before and after the policy. I found the payment decreased rehospitalization rates for rural relative to urban beneficiaries, but it is not cost-effective. Finally, in Chapter 3, I examined the degree of upcoding of activities of daily living and how it differs across home health agency characteristics. I used an imputation method to adjust for measurement bias and compared functional status measures across 2012-2014. I found that accounting for upcoding of activities of daily living does not substantially change home health agency quality measures.
Notes:: Thesis (Ph. D.)--Brown University, 2020

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Loomer, Lacey, "The Impact of the Home Health Rural Add-on Payment on Medicare Beneficiary Access and Outcomes" (2020). Health Services, Policy & Practice Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:1129361/

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Health Services, Policy & Practice Theses and Dissertations

Theses and Dissertations for the Health Services, Policy & Practice department.
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