Rural Medicare Beneficiaries and Frequent Emergency Department Users

Abstract

This dissertation presents three research studies aimed at understanding the healthcare of rural Medicare beneficiaries. The literature has described the health of rural residents, when compared to their urban counterparts, as poorer, sicker and with less access to healthcare. Thus, the purpose of this study was to measure changes between definitions of rurality, characterize the demographics of rural Medicare beneficiaries, identify the main reasons for emergency department (ED) utilization, and analyze rural beneficiaries’ patterns of ED use. These studies will fill a gap in the literature as there is no published research that has studied this topic using 100% of Medicare enrollment and claims data. This analysis was conducted using 2018 data Medicare data. These studies employed descriptive statistics, sensitivity testing, and logistic regression analyses. The results showed that, when compared to urban beneficiaries, rural beneficiaries were mostly white, women, age of 18-84, had a higher proportion of persons with disabled status, and had lower proportions of the oldest patients (85+). When comparing definitions of rurality, the Rural Urban Commuting Area (RUCA) codes assigned the largest number of beneficiaries as rural dwelling. Of all rural FFS Medicare enrollees, 23% used the emergency department at least once in 2018. Of those who used the ED, most only used the ED once. Among beneficiaries who used the ED, 14% returned to the emergency department four or more times (frequent ED users). Among the top reasons for ED use were chronic conditions related to heart and pulmonary diseases; symptoms of chronic conditions such as infection or inflammation; and issues related to falls such as syncope, collapse, and head injury. Finally, patterns of ED utilization were not affected by level of rurality. The results from this research suggest that, given the choice of rural classifications system to use, states would benefit most (have higher counts of rural beneficiaries) by using the RUCA codes. Rural Medicare beneficiaries who used ED services had a legitimate need to seek care outside of their local areas. Thus, by understanding the needs and utilization patterns of ED use for rural populations, healthcare systems can adapt to provide services vital to their communities.