The Impact of Medicare's Rural Add-on Payments in Home Health on Access to Care and Home Health Markets

项目摘要 医疗保险的家庭健康福利包括熟练的护理，康复 治疗，医疗社会工作和援助服务，为合格的受益人在自己的 木屋.家庭健康机构为更多的医疗保险受益人提供护理，而不是熟练的 护理设施和住院康复医院的总和。报销 家庭健康包括不同程度的附加支付机构时， 为农村受益人服务，以帮助应对在农村地区提供护理的挑战。 2001年至今，农村附加支付额占 标准偿还额各不相同，但在有些年份， 进行了目前还不清楚不同的农村附加支付对获得的影响 农村受益人的家庭健康以及机构如何应对变化 鼓励服务农村市场。 因此，本研究的目的是： 1)审查农村附加付款对农村人口获得保健的影响 受益人，以服务于农村地区的家庭保健机构的数量表示， 农村地区可获得的家庭保健服务的类型， 由服务农村地区的机构提供的护理。 2)从以下方面分析家庭卫生机构对农村附加支付的反应 进入和退出农村市场以及财务业绩和服务 提供服务于农村市场的机构。 结合Medicare Home 2002年至2014年的公开数据 健康比较，医疗保健成本报告信息系统，服务提供商 文件和地理变异公共使用文件，这种回顾性分析将采用 描述性和多层次回归建模方法，以提供第一个 全面评估农村附加付款对获得保健的影响 农村受益人和家庭保健市场。这项研究对以下方面具有重要意义： 医疗保险支付政策和解决几个弱势群体的服务， 包括生活在农村地区的个人、老年人、妇女和有 残疾和/或慢性疾病。结果将有助于为决策者提供信息， 医疗保险对农村家庭健康附加支付的影响和价值。

Project Summary Medicare’s home health benefit covers skilled nursing care, rehabilitation therapy, medical social work, and aide services for qualified beneficiaries in their own homes. Home health agencies provide care to more Medicare beneficiaries than skilled nursing facilities and inpatient rehabilitation hospitals combined. Reimbursement for home health has included varying levels of add-on payments for agencies when they serve rural beneficiaries to help meet the challenges of delivering care in rural areas. Between 2001 and the present, the amount of rural add-on payments as a percent of standard reimbursement has varied, though in some years no add-on payments were made. It is unclear what impact the varying rural add-on payments have had on access to home health for rural beneficiaries and how agencies have responded to changing incentives to serve rural markets. Therefore the aims of this study are to: 1) Examine the impact of rural add-on payments on access to care for rural beneficiaries in terms of the number of home health agencies serving rural areas, the types of home health services that are available in rural areas, and the quality of care provided by agencies who serve rural areas. 2) Analyze the response of home health agencies to rural add-on payments in terms of entry into and exit from rural markets and financial performance and service provision of agencies serving rural markets. Combining publicly available data from 2002 to 2014 from Medicare Home Health Compare, Healthcare Cost Report Information Systems, Provider of Services File, and Geographic Variation Public Use File, this retrospective analysis will employ descriptive and multi-level regression modeling approaches to provide the first comprehensive assessment of the impact of rural add-on payments on access to care for rural beneficiaries and home health markets. This study has critical implications for Medicare payment policy and addresses services for several vulnerable populations, including individuals living in rural areas, the elderly, women, and individuals with disabilities and/or chronic conditions. Results will help inform policymakers and Medicare on the impact and value of rural add-on payments in home health.