Report Shows Differences in Case-Mix between Rural and Urban

A recently released report by the Federal Office of Rural Health Policy, Health Resources and Services Administration shows that rural home health care patients generally are more ill than their urban counterparts, based on higher levels of diagnostic severity, more risk factors for hospitalization and poorer overall status which if nothing supports the need for the rural add-on. In adjusted analysis, rural residence was associated with higher odds that the patient would be in a fragile or serious condition. The report is based on a review of 1,468,465 unique beneficiary assessments from the 2010 Outcome Assessment Information Set (OASIS).

The report concludes that while “rural and urban recipients have similarities, rural beneficiaries pose unique challenges to home health providers and that these challenges may affect solvency of rural home health care providers. Further, payment reduction recommendations by MedPAC, that might be adopted by Congress, should be closely watched for unintended consequences whereby ultimately affecting the ability of rural Medicare beneficiaries’ ability to live independently without access to rural home health providers due to sweeping payment reductions affecting the overall solvency of those providers,” (report, page 7).

Key Facts in Rural Health Fact Sheet:

Key findings about all home health patients:

  • Overall, home health patients were severely impaired in their abilities for movement, self care, and medication management. This is an extremely vulnerable patient population: The majority (80.7 percent) were taking five or more medications.
  • Most patients (82.1 percent) had difficulty transferring, that is, moving from one position to another such as from lying in bed to standing.
  • A high proportion of patients could not walk either independently or with only a one-handed cane (73.7 percent).
  • Slightly more than half (53.1 percent) needed assistance to use a toilet, commode or bedpan; a substantial proportion (45.5 percent) were incontinent.
  • Slightly more than a quarter of patients (27.2 percent) had an open surgical wound that required care.

Key comparisons between rural and urban home health care patients:

  • Rural home health care patients were more ill than their urban counterparts, based on higher levels of diagnostic severity, more risk factors for hospitalization and poorer overall status. In adjusted analysis, rural residence was associated with higher odds that the patient would be in a fragile or serious condition.
  • Rural residents were more likely to receive respiratory treatments such as oxygen (21.1 percent rural, 14.6 percent urban). Need for respiratory therapies may be linked to the greater prevalence of reported smoking in rural cases (rural, 15.5 percent, urban 11.9 percent).
  • Rural residents were more likely to have a surgical wound that required care (rural, 29.8 percent, urban 26.7 percent).

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