The COVID pandemic disrupted nearly every aspect of healthcare delivery, including care following an acute care hospital stay or post-acute care (PAC). During the initial period of the pandemic, many patients and providers turned to home health care as a safer alternative to institutional PAC, like skilled nursing facilities (SNFs). In this blog, we examined how the use of institutional PAC has rebounded since the height of the COVID Public Health Emergency (PHE) and explored differences in trends between Traditional Medicare (TM) and Medicare Advantage (MA).
We analyzed Medicare administrative data from 2018 to 2024 to compare transfer rates from short-term acute care hospitals to institutional PAC settings (SNFs, inpatient rehabilitation facilities, and long-term care hospitals) and non-institutional settings (home health agencies (HHAs)). Using logistic regression, we accounted for age, sex, Medicare coverage type (i.e., TM or MA), and diagnosis-related groups (DRGs) to evaluate differences between MA and TM enrollees in PAC setting use over time. Two key findings emerged:
The PHE drove a significant shift from SNFs to HHAs due to several factors, including visitation restrictions, high rates of COVID transmission, and elevated mortality rates in SNFs. While transfer rates to institutional PAC settings have increased since the height of the PHE, transfer rates have remained fairly flat between 2022 and 2024. Although it is too early to draw any firm conclusions, our findings suggest that the increased use of non-institutional PAC providers during the pandemic may have permanent or long-lasting impacts on PAC use patterns. Given preferences for receiving care at home and its lower cost, the shift away from institutional PAC may be beneficial to beneficiaries and reduce Medicare spending. However, prior studies have documented that some Medicare beneficiaries may not receive recommended HHA. In addition, some high-need beneficiaries may not do as well at home as in an institutional setting. Future research should focus on assessing the benefits and risks associated with reduced use of institutional PAC providers, if the shift away from institutional PAC settings persists.
Services : Blog Expertise: Health Outcomes and Evaluation, Healthcare Cost and Utilization, home health care, Medicare, post-acute care
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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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Elizabeth Hamlett is a Senior Research Associate in the Evaluation and Health Economics practice at KNG Health. Ms. Hamlett has extensive experience in project management, the design and implementation of qualitative research (e.g., systematic literature reviews, surveys, and interviews), and in conducting analyses using Medicare inpatient and post-acute care claims data. Since joining KNG Health in 2015, her work has focused on evaluating the efficiency, effectiveness, and value of medical interventions, and supporting the Center for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement model through learning system activities, such as dissemination of information and data analysis. Ms. Hamlett has experience performing quantitative analyses with a variety of health care data sources, namely Medicare claims and Maryland Health Services Cost Review Commission data. Specifically, she has performed facility-level and condition specific outcome analyses and provided statistical support to multiple pharmaceutical companies in obtaining approval for New Technology Add-on Payments. In addition, Ms. Hamlett has led the design and development of interactive spreadsheet models for multiple projects including the Medicare Payment Advisory Committee’s proposed Hospital Value Incentive Program (HVIP) and CMS State Innovations Model (SIM) Maryland All-Payer Model. She has also performed statistical evaluation of quality measures proposed for inclusion in CMS’ ASC Quality Reporting Program in terms of reliability, validity, feasibility, and interpretability based on data collected through pilot testing for the Ambulatory Surgery Center Quality Collaboration (ASC QC). Prior to joining KNG Health, Ms. Hamlett managed a social psychology laboratory and worked with the non-profit organization, the Dialysis Clinic. Ms. Hamlett earned a Bachelor of Science in policy analysis and management from Cornell University in 2015. |
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