Examining Post Acute Care Relationships in an Integrated Hospital System. 3.1 Geographic Distribution of Providers

02/01/2009

This section provides an overview of the availability of PAC services throughout the United States. We focus on the overall distribution of providers by state, the number of providers per 1000 beneficiaries/state and the differences in the share that are freestanding versus hospital-based providers.

In 2007, according to analysis of the Online Survey and Certification Reporting System (OSCAR), there were almost 26,000 post-acute providers in the United States. The majority of PAC providers are the 15,056 SNFs and the 9,286 HHAs, followed by the 1,203 IRFs, and 397 LTCHs. The majority of SNFs, HHAs and LTCHs tend to be freestanding providers whereas IRFs are primarily hospital-based units.

As Figure 3-1 and Table 3-1 show, the geographic distribution of SNFs, IRFs, and LTCHs varies widely across the United States. Overall, Texas had the most PAC providers, with over 3,000. California, Florida, Ohio, and Illinois all had between 1,245 and 1,964 PAC providers in 2007. In contrast, 26 states (particularly in the Midwest and West regions) had fewer than 350 freestanding or hospital-based SNFs, IRFs, HHAs, and LTCHs in 2007.


Figure 3-1. Distribution of Freestanding versus Hospital-Based SNFs, IRFs, and Freestanding and HWH LTCHs in 2007

Figure 3-1. Distribution of Freestanding versus Hospital-Based SNFs, IRFs, and Freestanding and HWH LTCHs in 2007

Figure 3-1 is titled "Distribution of Freestanding versus Hospital-Based SNFs, IRFs, and Freestanding and HWH LTCHs in 2007." It is a map the total number of SNF, IRF, and LTCH providers by state. There are five levels of shading based on total number of providers per state. The levels of shading correspond to the following breakdowns: 1.) 73-310 facilities per state; 2.) 311-754 facilities per state; 3.) 755-1,364 facilities per state; 4.) 1,365-3,079 facilities per state; and 5.) 3,080-4,568 facilities per state. States with the fewest total providers include Nevada, Idaho, Montana, Utah, Wyoming, North Dakota, South Dakota, New Mexico, Alabama, Hawaii, West Virginia, Maine, New Hampshire, and Vermont. States with the highest number of total providers include California, Texas, Florida, Illinois, Ohio, and Pennsylvania. In addition to looking at the total number of providers per state, this map also displays the location of each type of freestanding or hospital-based provider across the United States. The source for this analysis was the 2007 POS data.

SOURCE: RTI analysis of 2007 POS data.


Table 3-2 shows the number of acute, SNF, IRF, and LTCH beds per 1,000 beneficiaries. This provides more information on the supply of post-acute care relative to the Medicare beneficiary population in each state. The picture of availability changes somewhat once we control for population size. Texas, which has the highest number of PAC providers, also ranks very high in the number of beds per beneficiary. However, after controlling for Medicare beneficiaries residing in the state, Texas ties with Nevada for the state with the fourth highest number of IRF beds per 1,000 beneficiaries (1.53 beds per 1,000 beneficiaries) but ranks 16th in the number of SNF beds per 1,000 beneficiaries (45.22 beds per 1,000 beneficiaries) and 5th in the number of LTCHs bed per 1,000 beneficiaries (1.51 beds per 1,000 beneficiaries). The other high volume states, such as California are not among the top 20 in terms of beds per 1,000 beneficiaries. States with the highest supply of IRF beds per beneficiary included the District of Columbia (2.66 beds per 1,000 beneficiaries), Louisiana (2.09 beds per 1,000 beneficiaries), Arkansas (1.82 beds per 1,000 beneficiaries), and Texas and Nevada (both 1.53 beds per 1,000 beneficiaries). The states with the highest supply of SNF beds per beneficiary population included North Dakota (62.69 beds per 1,000 beneficiaries), Iowa (59.98 beds per 1,000 beneficiaries), and Louisiana (57.66 beds per 1,000 beneficiaries). The two states with the highest number of LTCH beds per beneficiary included Massachusetts (3.92 beds per 1,000 beneficiaries) and Louisiana (3.08 beds per 1,000 beneficiaries). Delaware was the state with the lowest supply of acute hospital beds per beneficiary (2.90 beds per 1,000 beneficiaries), Maryland had the fewest IRF beds per beneficiary (0.19 beds per 1,000 beneficiaries), Alaska had the fewest SNF beds per beneficiary (11.14 beds per 1,000 beneficiaries), and seven states had no LTCH beds (Montana, New Hampshire, Alaska, Iowa, Maine, Vermont, and Oregon). This analysis demonstrates the variation in supply of providers across the nation as well as the variation in supply of providers per Medicare beneficiary. This variation has implications for use of services during episodes of post-acute care.

Table 3-1. Number of Acute and Post-Acute Providers, by State, 2007

State Acute
Hospital
SNF IRF LTCH HHA
Hospital
Based
Free-
standing
Hospital
Based
Free-
standing
HwH Free-
standing
Hospital
Based
Free-
standing
SOURCE: RTI analysis of 2007 POS data (ASPEPAC2_MM31).
Total 4,961 1,127 13,929 983 220 139 258 1,602 7,684
Alabama 103 16 213 10 7 1 5 45 101
Alaska 23 11 4 3  –  –  – 9 7
Arizona 80 3 132 17 6 1 4 13 73
Arkansas 79 15 200 19 8 2 4 58 116
California 357 134 1063 73 6  – 14 80 628
Colorado 74 14 179 16 3 3 4 26 110
Connecticut 33 5 239 8 1  – 3 5 80
Delaware 5 2 36 3  – 1  – 2 17
District of Columbia 7 5 14 2 1  – 2 1 24
Florida 186 16 661 30 14  – 12 31 811
Georgia 145 48 309 30 3 4 11 29 72
Hawaii 23 17 26  – 1  – 1 6 8
Idaho 42 17 59 5 1  – 1 16 33
Illinois 185 56 647 43 4  – 6 70 428
Indiana 117 23 466 36 7 9 3 52 159
Iowa 118 26 389 14  –  –  – 68 109
Kansas 145 12 257 17 4 3 2 57 78
Kentucky 96 31 261 12 6 6 1 36 68
Louisiana 131 21 271 31 22 10 31 23 198
Maine 40 9 104 4 1  –  – 6 23
Maryland 47 17 211  – 2  – 4 6 43
Massachusetts 70 14 424 6 8  – 17 14 114
Michigan 145 25 379 48 4 11 9 39 361
Minnesota 133 55 325 17 1  – 2 78 137
Mississippi 101 14 157 14  – 7 3 15 41
Missouri 115 20 465 32 4 3 4 57 114
Montana 62 32 59 5  –  –  – 25 11
Nebraska 87 8 188 7 1 2  – 44 29
Nevada 34 9 37 9 3 2 3 4 67
New Hampshire 26 3 71 3 2  –  – 4 32
New Jersey 75 15 347 8 8  – 7 14 35
New Mexico 41 4 63 4 5 1 1 13 55
New York 206 67 588 70  –  – 4 73 118
North Carolina 115 36 384 21 2 3 4 35 134
North Dakota 45 16 67 4  – 2  – 18 5
Ohio 171 40 916 54 3 13 8 68 411
Oklahoma 127 12 268 21 2 3 11 55 159
Oregon 58 4 117 10  –  –  – 34 23
Pennsylvania 170 59 650 64 18 12 11 59 266
Puerto Rico 52 5 3 1 1  –  – 4 45
Rhode Island 11 1 85 4 1  – 1 2 20
South Carolina 60 16 157 12 5 2 4 17 51
South Dakota 62 12 81 5  – 1  – 27 15
Tennessee 125 22 277 25 6 7 2 29 110
Texas 394 37 1,038 84 34 26 46 89 1,740
Utah 40 9 76 8 1  – 3 8 65
Vermont 14 3 37 3  –  –  –  – 12
Virginia 90 18 239 18 7  – 4 42 146
Washington 89 12 222 21 1 1 1 25 35
West Virginia 55 26 97 2 5 1 1 26 35
Wisconsin 124 25 347 27 1 2 2 33 95
Wyoming 26 10 23 3  –  – 1 12 15

Table 3-2. Beds per 1,000 Beneficiaries, 2007

State Acute Beds
Per 1,000
Beneficiaries
IRF Beds
Per 1,000
Beneficiaries
SNF Beds
Per 1,000
Beneficiaries
LTCH Beds
Per 1,000
Beneficiaries
SOURCE: RTI analysis of 2007 POS data (ASPEPAC2_MM31).
Alabama 18.73 0.92 34.65 0.53
Alaska 15.82 0.51 11.14 0.00
Arizona 11.06 0.92 19.20 0.30
Arkansas 12.17 1.82 45.17 0.47
California 12.33 0.55 26.43 0.35
Colorado 10.71 0.99 34.24 0.78
Connecticut 9.78 0.36 56.83 1.27
Delaware 2.90 0.75 33.34 0.28
District of Columbia 36.53 2.66 32.26 1.68
Florida 11.31 0.76 25.99 0.24
Georgia 13.45 0.88 37.61 0.69
Hawaii 12.90 0.56 21.52 0.06
Idaho 8.87 0.72 31.41 0.21
Illinois 15.33 0.98 38.35 0.55
Indiana 9.88 1.26 50.86 0.66
Iowa 13.56 0.55 59.98 0.00
Kansas 18.90 1.27 47.76 0.42
Kentucky 16.83 1.05 37.30 0.83
Louisiana 12.45 2.09 57.66 3.08
Maine 11.68 0.77 28.36 0.00
Maryland 19.05 0.19 36.56 0.68
Massachusetts 12.00 1.24 49.53 3.92
Michigan 8.89 0.90 30.09 0.65
Minnesota 10.37 0.56 47.87 0.52
Mississippi 18.19 0.85 34.47 0.87
Missouri 12.20 1.04 48.62 0.50
Montana 12.21 0.80 47.71 0.00
Nebraska 15.56 0.77 54.56 0.53
Nevada 9.86 1.53 18.26 0.84
New Hampshire 13.12 1.10 38.98 0.00
New Jersey 18.93 0.87 40.85 0.31
New Mexico 12.79 1.18 23.76 0.33
New York 12.08 0.86 43.73 0.37
North Carolina 11.25 0.72 33.35 0.33
North Dakota 14.61 0.86 62.69 0.70
Ohio 11.77 0.76 53.17 0.69
Oklahoma 14.07 1.25 47.60 1.17
Oregon 8.84 0.30 19.95 0.00
Pennsylvania 6.92 1.41 39.94 0.62
Rhode Island 10.78 0.93 49.75 2.90
South Carolina 13.38 0.92 26.85 0.46
South Dakota 12.84 1.01 47.21 0.19
Tennessee 17.81 1.17 29.34 0.36
Texas 11.93 1.53 45.22 1.51
Utah 8.64 0.94 31.89 0.48
Vermont 8.03 0.60 33.00 0.00
Virginia 11.88 0.76 26.43 0.18
Washington 8.17 0.57 25.01 0.13
West Virginia 20.89 0.90 27.44 0.17
Wisconsin 8.69 0.79 43.42 0.19
Wyoming 13.64 0.63 40.32 0.04
 

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