Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge

Abstract

This study provides evidence of lower quality postdischarge care for Medicare beneficiaries in rural settings. As readmission penalties expand, hospitals serving rural beneficiaries may be disproportionately affected. This suggests a need for policies that increase follow-up care in rural settings.

ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults

“…1 There is some evidence that rural dwelling Medicare beneficiaries have a lower probability to have primary care follow up; and that they may be at greater risks to accessing the ED in the 30 days post hospitalization, when compared to urban counterparts. 42 However, in this study we found no significant association between non-urban or urban community-dwelling participants and their ED utilization. This finding is similar to another study where rural dwelling older adults’ ED utilization did not differ significantly compared to their more urban counterparts.…”

“…43 It has been shown that insufficient physical activity leads to decreased muscle strength and functional impairment which has also been associated with falls. 41,42 …”

Rural Health Care Costs

“…Of course, these barriers to access may ultimately lead to higher costs. Although rural residents are less likely to have a follow-up visit to an inpatient stay (saving the cost of an office visit), this leads to increased rates of emergency department use, costing thousands [4]. Thus, there are compelling reasons to expect rural costs to be higher.…”

Rural–Urban Differences in the Effect of Follow‐Up Care on Postdischarge Outcomes

“…), a recent study found rural Medicare beneficiaries transitioning from the hospital to home had a higher risk of visiting the ED and a lower rate of follow‐up care during a 30‐day post discharge period, compared to urban beneficiaries (Toth et al. ). While there was no relationship between rural residency and readmission, beneficiaries discharged from a rural hospitals had a greater risk of readmission, compared to being discharged from urban hospitals.…”

“…The effective use of post discharge services among rural Medicare beneficiaries is poorly understood; however, studies suggest that rural beneficiaries may be at greater risk of using acute care services postdischarge. Although rural and urban beneficiaries have similar access to overall care (Stensland et al 2013), a recent study found rural Medicare beneficiaries transitioning from the hospital to home had a higher risk of visiting the ED and a lower rate of follow-up care during a 30-day post discharge period, compared to urban beneficiaries (Toth et al 2015). While there was no relationship between rural residency and readmission, beneficiaries discharged from a rural hospitals had a greater risk of readmission, compared to being discharged from urban hospitals.…”