Objectives/Goals: Speech-language pathology (SLP) is essential to restore communication, swallowing, and cognition. Research on access to SLP services in rural communities is sparse. In this cross-sectional descriptive study, we analyze access to SLP services among traditional Medicare beneficiaries offered via urban and rural Home Health Agencies (HHA). Methods/Study Population: To describe access to SLP services at home among traditional Medicare beneficiaries in 2022, we analyzed three provider-level datasets from the Centers for Medicare and Medicaid Services: The Post-Acute Care and Hospice Provider Utilization and Payment Public Use File, the Care Compare dataset, and the Provider of Services dataset. We grouped HHAs into five rural and urban categories: urban serving <10% rural beneficiaries (n=6001), urban serving 10%+ rural beneficiaries (n=458), large rural (n=755), small rural (n=431), and isolated small rural (n=148). We used descriptive statistics to assess SLP service provision and SLP staffing patterns. A logistic regression model was conducted to analyze how service provision varies by agency characteristics. Results/Anticipated Results: According to agency self-report, the likelihood of offering services was highest among urban HHAs and decreased as rurality increased. However, the number of HHAs that actually provided SLP therapy minutes in 2022 was lower. Urban HHAs serving less than 10% rural beneficiaries and isolated small rural agencies were least likely to have provided SLP services (71% and 59% of agencies provided services). In adjusted analyses, larger agencies were more likely to have documented service provision, while accredited agencies were less likely to have provided services. HHAs that actually provided services were more likely to have SLP staff employed by the agency rather than contract SLPs. Among agencies with documented service provision, the majority of agencies employed less than 0.5 full-time equivalent SLPs. Discussion/Significance of Impact: Small independent agencies in isolated rural areas may struggle to fill open positions or consistently offer SLP positions due to fluctuating SLP needs. Efforts to improve access to home health SLP services should focus on supporting these agencies to improve SLP recruitment and retention.
Dhanaraj et al. (Wed,) studied this question.