The Centers for Medicare & Medicaid Services (CMS), in collaboration with The RAND Corporation, published a report summarizing the disparities in healthcare quality between rural and urban areas for people with Medicare nationwide.
The report highlights:
· Rural-urban differences in healthcare experiences and clinical care.
· How rural-urban differences in healthcare experiences and clinical care vary by race and ethnicity.
· Historical trends in quality of care for rural and urban residents.
Key findings:
Rural-urban differences in care received in Reporting Year 2023
· Overall, Medicare Advantage (MA) enrollees living in rural areas had results that were below the national average for more than a third of all clinical care measures examined. This is considerably larger than the percentage of measures for which MA enrollees living in rural areas had below average results in Reporting Year 2022 data (presented in last year’s edition of this report). As in Reporting Year 2022 data, MA enrollees living in urban areas had scores on clinical care measures in Reporting Year 2023 data that were nearly always similar to the national average.
· The largest deficits in clinical care for rural residents were for kidney health evaluation for patients with diabetes (a 15-percentage-point deficit for MA enrollees living in rural areas), avoidance of potential drug-disease interactions in both older patients with dementia (an 8 percentage-point deficit) and patients with a history of falls (a 5-percentage point deficit), osteoporosis screening in older women (a 7-percentage point deficit), and osteoporosis management in women who had a fracture (a 6-percentage-point deficit).
· This analysis also uncovered considerably lower rates of flu vaccination among rural versus urban residents in Reporting Year 2023 data. As it was in Reporting Year 2022 data, this disadvantage was observed among both MA enrollees and people with FFS coverage and was evident across racial and ethnic groups.
· Although there were no overall rural-urban differences in experiences with care that met the 3 point magnitude criterion used in this report, there was a consistent pattern of small statistically significant differences favoring rural residents. This pattern was also seen in Reporting Year 2022 CAHPS data.
Rural-urban differences in care received in Reporting Year 2023, by race and ethnicity
· The overall pattern of urban residents having Reporting Year 2023 scores on clinical care measures that were similar to the national average and rural residents often having scores that were below the national average was evident among all racial and ethnic groups except Hispanic MA enrollees. Whereas in urban areas Hispanic MA enrollees had results that were generally similar to the national average for all Hispanic MA enrollees, in rural areas they had results that were below the national average on nearly 40 percent of measures and above the national average on nearly a quarter of measures. This unique pattern of results for rural Hispanic MA enrollees was also seen in Reporting Year 2022 HEDIS data.
· A large portion of the below average results observed for rural Hispanic MA enrollees were in the area of behavioral healthcare.
Trends in quality of care for rural and urban residents, 2017–2023
· For 5 of the 10 HEDIS measures included in the trend analysis, scores increased for urban and rural residents from Reporting Year 2017 to Reporting Year 2023 but did so more for rural residents than for urban residents. As a result, in all of these cases initial advantages for MA enrollees living in urban areas (relative to the national average) remained about the same while initial gaps for MA enrollees living in rural areas shrank.
· For the other five HEDIS measures included in the analysis, scores either remained the same or increased similarly for rural and urban residents from Reporting Year 2017 to Reporting Year 2023, maintaining initial gaps for rural residents relative to the national average and initial advantages for urban residents relative to the national average.
· For the one CAHPS measure that was included in the trend analysis, Annual Flu Immunization, scores increased for MA enrollees in both urban and rural areas in a way that was comparable to the national average for all MA enrollees. As a result, an initial (i.e., Reporting Year 2017) advantage for MA enrollees living in urban areas remained about the same in Reporting Year 2023, as did an initial gap for MA enrollees living in rural areas. Scores on this measure also increased for people with FFS coverage living in urban and rural areas. However, whereas the increase for people with FFS coverage living in urban areas was comparable to the national average for all people with FFS coverage, the increase for people with FFS coverage living in rural areas was less than the national average for all people with FFS coverage, resulting in a widening of an initial gap for people with FFS coverage living in rural areas.
