Rural-urban differences in receipt of home health care services among Medicare beneficiaries with cerebrovascular disease

Purpose:This study examines the rural-urban differences in the distribution and duration of home health (HH) services and type of service providers among Medicare beneficiaries with cerebrovascular disease (CVD).

Method:A cross-sectional analysis was conducted using data obtained from the CMS Research Data Center linked with data drawn from the Area Resource File. Wald chi-square tests (alpha=.05) were conducted to test differences between the types of services (CVD associated vs. non-associated), duration of services (average number of HH visits per claim), and their providers by rurality.

Results:More HH service claims were associated with CVD in rural areas compared to urban areas (18.0% v 17.0%, p=0.04). Urban beneficiaries had an average of 21.4 visits per claim, while rural beneficiaries had 17.9 visits (p<0.0001). In urban counties, physical therapists provided a larger proportion of HH services (72.9% v 67.2%, p<0.0001), while in rural counties, licensed practical nurses (LPN) or registered nurses (RN) provided a greater proportion of HH services (29.0 v 23.8%, p<0.0001).

Conclusion:Rural-urban disparities were evident in types and duration of HH services and service providers among Medicare beneficiaries with CVD. While rural beneficiaries with CVD had more claims associated with their condition, the duration of services was less compared to their urban peers. Physical therapists were the major service providers in urban counties, while LPNs and RNs were the major service providers in rural counties. These findings indicate rural residents received a lower level of service than their urban counterparts. Policymakers should consider addressing this disparity via provider placement services.