With support from The Commonwealth Fund, KNG Health estimated the extent to which post-hospital home health (HH) use increased among traditional Medicare beneficiaries during the COVID-19 public health emergency. We found large shifts in hospital discharges toward HH across all groups during 2020 driven, in large part, by reductions in discharges to skilled nursing facilities (SNFs).
As a lower cost setting, the increased use of HH may drive Medicare program savings but with uncertain impact on outcomes. To begin to understand the potential impact of shifting post-acute care patterns, we assessed changes in hospital discharge volume to HH and SNFs by Medicare-Severity Diagnosis Related Group (MS-DRG) and patient complexity between October 2019-February 2020 and March 2020-December 2020 for the MS-DRGs with the highest HH volume prior to COVID-19. We use the period from October 2019 through February 2020 as our pre-COVID-19 baseline, because a new Medicare payment system for SNFs was implemented on October 1, 2019. To measure patient complexity, we mapped the comorbidities and complications (CCs) and major CCs (MCCs) lists created by the Centers for Medicare & Medicaid Services to a patient’s hospital claim and counted the number of CCs and MCCs.
Home health’s share of discharges increased 4 to 9 percentage points among the top 25 MS-DRGs determined based on HH volume, including septicemia or severe sepsis, major hip and knee joint replacement, heart failure and shock. The corresponding decreases in the SNF share ranged from 2 to 13 percentage points. After stratifying by complexity, we generally found increases in HH use and decreases in SNF use across all complexity categories. Further, for many of the MS-DRGs examined (20 MS-DRGs out of the top 25), we observed a larger shift toward HH among more complex cases. For example, looking at patients with major hip and knee joint replacement or reattachment of lower extremity without MCC (MS-DRG 470), HH’s share of patients has increased 6 percentage points for those with fewer than 3 CCs. In contrast, HH’s share of patients with 6 or more CCs increased by 9 percentage points. The corresponding decrease in SNF’s share was 4 and 10 percentage points, respectively.
To better understand the implications of this shift on the Medicare population, we are examining the extent of the shift for several sub-populations: Black beneficiaries, dual eligible, high-cost, and high-needs patients. We are also analyzing health outcomes and Medicare spending associated with the abrupt shift in PAC use observed during the COVID-19 public health emergency.
Note: HHA – Home Health Agency; SNF – Skilled Nursing Facility; CC – Comorbidities and Complications; MCC – Major Comorbidities and Complications
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Inna Cintina is a Principal Research Associate in the Evaluation and Health Economics Practice. Dr. Cintina is an applied microeconomist with over a decade of research experience in the area of health economics. At KNG Health, Dr. Cintina is leading evaluations of the impact of managed care on high-need Medicare beneficiaries. Specifically, in work supported by a grant from Arnold Ventures, she is studying the distribution of high-need beneficiaries across enrollment types (Traditional Medicare, Accountable Care Organization (ACOs); and Medicare Advantage (MA)), healthcare services utilization and health outcomes in high-need beneficiaries attributed to ACOs relative to those in MA; and characteristics of MA plans associated with better health outcomes among enrollees. In other work, she studied disparities in utilization of new cardio- and neuro-vascular technologies and impacts of post-acute care settings on beneficiary outcomes. She is an expert in using matching techniques, difference-in-difference methodologies, and other quasi-experimental statistical approaches, as well as producing client-oriented materials, white papers, and manuscripts. She has authored/co-authored more than a dozen articles, which have been published in peer-reviewed journals such as World Bank Economic Review, Health Economics, JAMA, Value in Health, and the American Journal of Managed Care. Prior to joining KNG Health, Dr. Cintina worked at the Lewin Group/OptumServe and the University of Hawaii at Manoa. She has extensive experience in developing and implementing methodologies for identification of causal relationships, advanced analytics, project management, economic burden/cost of illness studies, and impact evaluations of alternative payment models, such as CMMI’s Bundled Payments for Care Improvement Initiative and Oncology Care Model. Dr. Cintina has a PhD in economics from Clemson University, a MSC in European Economics and Public Affairs from University College Dublin, and an MA and a BA in economics from the University of Latvia. |
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Marie Steele-Adjognon was formerly a Research Director at KNG Health Consulting. |
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Lane Koenig is President and Founder of KNG Health Consulting and Director of the Healthcare Reform and Payment Innovation Practice. He is a healthcare economist with over 20 years’ experience in the public and private sectors. As President of KNG Health Consulting, Dr. Koenig has overall responsibility for the quality and direction of KNG Health’s research. He serves as Project Director and Principal Investigator for many studies, particularly those related to healthcare reform proposals, healthcare provider payments, value-based purchasing, and delivery system innovations. With expertise on hospital and post-acute care payment and quality issues, his work regularly assesses the potential impact on hospitals and other providers of proposed legislation or regulations. He has assisted both industry and Federal and state governments in the development and assessment of healthcare provider payment policies and value-base purchasing initiatives. Prior to founding KNG Health in 2007, Dr. Koenig was the senior economist in the Office of Policy at the Centers for Medicare & Medicaid Services (CMS). Before joining CMS, Dr. Koenig was a Senior Scientist in the healthcare finance practice at The Lewin Group. Dr. Koenig has led over 100 quantitative and qualitative health policy and health economic studies and has published over 20 peer-reviewed studies in journals, such as Health Affairs, Health Services Research, and Medical Care. He graduated with Honors from the University of Florida, Gainesville and earned his PhD in Economics from the University of Maryland, College Park. |
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