Rural patients less likely to receive follow-up care after discharge

Rural Medicare patients have lower rates of follow-up care after discharge, an important safeguard against preventable readmissions and other complications, according to a new study published in Medical Care.

Researchers, led by Matthew Toth, Ph.D., then of the University of North Carolina Chapel Hill, analyzed data from the Medicare Current Beneficiary Survey covering about 12,000 Medicare patients admitted to hospitals between 2000 and 2010, about a third of whom lived in rural communities. Toth and his team further divided the rural patients into those living in large, small and isolated areas.

Comparing rural and urban patients based on follow-up visits, emergency room visits and unplanned readmissions in the first 30 days after hospital discharge, researchers found those in isolated rural areas were 19 percent less likely than their urban counterparts to receive follow-up care. They also found a 44 percent higher risk of ED visits for patients in small rural areas and a 52 percent higher risk for those in large ones.

Risk of readmission was not significantly higher for those living in rural areas than those in urban areas, but when Toth and his team looked at the numbers by hospital location rather than residency, those in large and small rural areas were 32 percent and 42 percent more likely to be readmitted, respectively.

These findings, Toth said in a statement, backed up existing research that Medicare's Hospital Readmissions Reduction Program disproportionately penalizes rural providers.

Now healthcare leaders must look into what drives these disparities, he added. For example, are patients at rural hospitals discharged to under-resourced settings or are there gaps in post-discharge instructions?

Bipartisan legislation introduced earlier this year proposed to incorporate sociodemographic data into the formula for calculating readmission rates, FierceHealthcare previously reported.

"This recalibration ensures hospital performance is compared equally while maintaining an incentive for all hospitals to reduce unnecessary readmissions," American Hospital Association Executive Vice President Rick Pollack wrote.

To learn more:
- read the study abstract
- here's the statement