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

项目摘要 Medicare的家庭健康福利包括熟练的护理、康复 为符合条件的受益人提供治疗、医务社会工作和援助服务 家。家庭健康机构为更多的联邦医疗保险受益人提供护理 护理设施和住院康复医院加在一起。报销 家庭健康包括为机构提供不同水平的附加付款，当他们 为农村受益者提供服务，以帮助应对在农村地区提供护理的挑战。 从2001年到现在，农村附加费的金额占 标准报销有所不同，尽管在某些年份没有附加付款 制造。目前还不清楚不同的农村附加支付对访问权限产生了什么影响 农村受益者的家庭健康以及各机构如何应对变化 服务农村市场的激励措施。 因此，本研究的目的是： 1)审查农村附加费对获得农村保健的影响 受益者在为农村地区提供服务的家庭保健机构数量方面， 农村地区可提供的家庭保健服务的类型和质量 由为农村地区服务的机构提供的护理。 2)从以下几个方面分析家庭保健机构对农村附加费用的反应 进入和退出农村市场与金融业绩和服务 提供服务农村市场的中介机构。 综合2002年至2014年联邦医疗保险之家的公开数据 健康比较，医疗成本报告信息系统，服务提供商 文件和地理变异公共使用文件，该回溯分析将采用 描述性和多水平回归建模方法提供了第一 全面评估农村附加费对获得护理的影响 针对农村受益者和家庭保健市场。这项研究对以下方面有重要影响 医疗保险支付政策，并为几个弱势群体提供服务， 包括生活在农村地区的个人、老年人、妇女和有残疾的个人 残疾和/或慢性疾病。结果将有助于向政策制定者和 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.