10.1177/0898264305276288 JOURNAL OF AGING AND HEALTH / June 2005 Lin, Meit / CHANGES IN MEDICARE USE AND PRACTICE Changes in Medicare Home Health Care Use and Practices in Rural Communities 1997 to 2001 Chyongchiou Jeng Lin Michael Meit University of Pittsburgh Objectives: This research was designed to examine the impact of the interim and pro- spective payment systems on home health agencies and Medicare beneficiaries in rural communities. Methods: Data were collected from two complementary studies: (a) fiscal and use data collected from 10 rural agencies in northwest Pennsylvania and (b) a statewide survey of rural home health agencies in Pennsylvania. Results: The findings show that the implementation of interim and prospective payment systems had a profound affect on the home health agencies’ financial vulnerability, staffing management, and service delivery. As a result, Medicare beneficiaries were also affected. The total number of home health visits per episode in rural Pennsylvania was 16 visits, whereas the national estimate was 22 visits. Physical therapy services increased 8% and occupational therapy services increased 1%, whereas visits for other disciplines decreased or remain unchanged. Discussion: Future studies are needed to examine the health outcomes of beneficiaries in rural communities. Keywords: home health; Medicare; prospective payment system Between 1990 and 1997, Medicare spending on home health services grew from $3.7 billion to $17.8 billion (Center for Medicare and Medicaid Services, 2003; Medicare Payment Advisory Commission, 2002, 2003; Figure 1). The rapidly rising home health costs served as 351 AUTHORS’ NOTE: This research was partly supported by the Health Resources and Ser- vices Administration, Federal Office of Rural Health Policy, and by the Center for Rural Penn- JOURNAL OF AGING AND HEALTH, Vol. 17 No. 3, June 2005 351-362 DOI: 10.1177/0898264305276288 © 2005 Sage Publications