Some 4 out of 10 Medicare beneficiaries in rural areas with planned discharges to home hospital agencies (HHAs) didn’t actually receive that HHA care, according to a new study entitled “Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies.” 

In the study, the University of Washington provided an analysis of administrative data for the cohort of all fee-for-service Medicare beneficiaries residing in rural areas who were discharged alive from an acute care hospital in 2013. It also found the following:

• More than half (56.3%) of rural, fee-for-service Medicare beneficiaries did not have any care transitions to an HHA, skilled nursing facility (SNF),  inpatient rehabilitation facility, long-term care hospital or an acute care hospital.

• Nearly 9 out of 10 (88.9%) of rural beneficiaries who had a planned discharge to a SNF received SNF care following acute hospital discharge.

A graph from the March 2021 University of Washington rural discharges report
This graph shows the gulf between planned versus actual discharges to home health agencies following hospitalization. Source: Rural Health Research Center, University of Washington.

The study noted that the difference between planned versus actual HHA care may have to do with the coordination required for HHA care, versus SNF care.

“It is perhaps unsurprising that fewer beneficiaries with planned discharge to an HHA received services, as compared with receipt of planned SNF services,” the study said. “Discharging hospitals assist in finding available SNF beds, gaining approval, and arranging transportation for discharge to a SNF, so patients transition directly from acute care hospital discharge to a SNF admission. In contrast, a patient may discharge to home with a referral for home health services but without all arrangements secured. To receive HHA services, the patient and/or caregiver must follow-up with an HHA to schedule visits. Patients may also agree to services from an HHA at hospital discharge but then refuse services upon returning home.”