Changes in Medicare Home Health Care Use and Practices in Rural Communities

Abstract

Objectives: This research was designed to examine the impact of the interim and prospective payment systems on home health agencies and Medicare beneficiaries in rural communities. Methods: Data were collected from two complementary studies: (a) fiscal and use data collected from 10 rural agencies in northwest Pennsylvania and (b) a statewide survey of rural home health agencies in Pennsylvania. Results: The findings show that the implementation of interim and prospective payment systems had a profound affect on the home health agencies’ financial vulnerability, staffing management, and service delivery. As a result, Medicare beneficiaries were also affected. The total number of home health visits per episode in rural Pennsylvania was 16 visits, whereas the national estimate was 22 visits. Physical therapy services increased 8% and occupational therapy services increased 1%, whereas visits for other disciplines decreased or remain unchanged. Discussion: Future studies are needed to examine the health outcomes of beneficiaries in rural communities.