Different Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute versus Community-entry Home Health in Rural Areas


  • Abstract

    Rural, fee-for-service Medicare beneficiaries who are admitted to home health from the community (community-entry) are significantly different from those who are admitted to home health following an inpatient stay (post-acute). Higher rates of community-entry were seen among beneficiaries who were older, female, non-white, living alone, and dually eligible for Medicare and Medicaid, and who had lower clinical severity, lower functional status, more cognitive impairment, and higher need for caregiver assistance for supervision and safety.
    Wide variation by state exists in rates of community-entry home health episodes for rural beneficiaries, even after controlling for beneficiary characteristics. Maryland had the lowest percentage of community-entry home health episodes as a percentage of all home health episodes (17.6%), while Texas had the highest (38.8%).
    County-level community characteristics—including rurality, persistent poverty, population loss, number of acute hospital beds, number of skilled nursing facility beds, number of home health agencies, and state-level Medicaid expenditures on home- and community-based services—also have significant but relatively small associations with rates of community-entry compared with state and beneficiary characteristics.


  • Authors:

    Mroz TM, Andrilla CHA, Garberson LA, Skillman SM, Patterson DG, Wong JL, Larson EH

  • Journal/Publisher:

    Seattle, WA: WWAMI Rural Health Research Center, University of Washington

  • Edition:

    Jul 2018. Policy Brief #165

  • Documents:

    Policy Brief 165

  • Citation:

    Mroz TM, Andrilla CHA, Garberson LA, Skillman SM, Patterson DG, Wong JL, Larson EH. Different populations served by the Medicare home health benefit: comparison of post-acute versus community-entry home health in rural areas. Policy Brief #165. Seattle, WA: WWAMI Rural Health Research Center, University of Washington, Jul 2018.

  • Related Studies:

    Diverging Populations Served by the Medicare Home Health Benefit: Comparison of Post-acute vs. Community-entry Home Health in Rural Areas