<scp>Post‐hospital</scp> home health use increased for <scp>non‐COVID</scp> Medicare patients during <scp>COVID</scp>‐19, particularly among complex cases

Cintina, Inna; Koenig, Lane; Steele-Adjognon, Marie

doi:10.1111/jgs.18136

Cited by 4 publications

(5 citation statements)

References 2 publications

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“…In the integration cohort, there was a differential increase in postacute home health use by the third postyear (2020), coinciding with the COVID-19 pandemic. However, it is unclear whether this reflects a change associated with integration vs a pandemic-associated shift in postacute care toward home-based settings …”

Section: Resultsmentioning

confidence: 99%

“…However, it is unclear whether this reflects a change associated with integration vs a pandemic-associated shift in postacute care toward home-based settings. 34 Finally, there was a differential increase in days of long-stay nursing home care in the integration cohort, reflecting a greater decline in days in the comparison vs integration cohorts after 2017.…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 92%

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Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals

Roberts,

Xue,

Lovelace

et al. 2023

JAMA Health Forum

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ImportanceThere is growing interest in expanding integrated models, in which 1 insurer manages Medicare and Medicaid spending for dually eligible individuals. Fully integrated dual-eligible special needs plans (FIDE-SNPs) are one of the largest integrated models, but evidence about their performance is limited.ObjectiveTo evaluate changes in care associated with integrating Medicare and Medicaid coverage in a FIDE-SNP in Pennsylvania.Design, Setting, and ParticipantsThis cohort study using a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted between February 2022 and June 2023.Main Outcomes and MeasuresAnalyses examined outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays.ResultsThe study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. In the integration cohort, the mean (SD) age at baseline was 63.3 (14.7) years, and 5268 individuals (66.1%) were female and 2699 (33.9%) were male. In the comparison cohort, the mean (SD) age at baseline was 64.8 (18.6) years, and 2341 individuals (61.1%) were female and 1491 (38.9%) were male. At baseline, integration cohort members received a mean (SD) of 2.83 (8.70) days of HCBS per month and 3.34 (3.56) medications for chronic conditions per month, and the proportion with a follow-up outpatient visit after a hospital stay was 0.47. From baseline through 3 years after integration, HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month (95% CI, 0.28-0.94; P &lt; .001). However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (−0.02 fills/person-month; 95% CI, −0.10 to 0.06; P = .65) or follow-up outpatient care after a hospital stay (−0.01 visits/hospital stay; 95% CI, −0.04 to 0.03; P = .61). Hospital stays did not change differentially between the cohorts. Unmeasured factors contributing to differential mortality limited the ability to identify changes in long-term nursing home stays associated with integration.Conclusions and RelevanceIn this cohort study with a difference-in-differences analysis of 2 cohorts of individuals dually eligible for Medicare and Medicaid, integration was associated with greater HCBS use but not with other changes in care patterns. The findings highlight opportunities to strengthen how integrated programs manage care and a need to further evaluate their performance.

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Section: Resultsmentioning

confidence: 99%

Section: Jama Health Forum | Original Investigationmentioning

confidence: 92%

Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals

Roberts,

Xue,

Lovelace

et al. 2023

JAMA Health Forum

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“…16 This has been driven in part by a shift toward the use of home-based settings for post-acute care rather than SNFs. 36,37 SNFs also face serious problems with hiring and retaining staff. 12 SNF employment remains well below pre-pandemic levels.…”

Section: Discussionmentioning

confidence: 99%

“…SNF occupancy rates declined substantially during the pandemic and have yet to recover 16 . This has been driven in part by a shift toward the use of home‐based settings for post‐acute care rather than SNFs 36,37 . SNFs also face serious problems with hiring and retaining staff 12 .…”

Section: Discussionmentioning

confidence: 99%

Medicare Advantage growth and skilled nursing facility finances

Marr,

Shen

2024

Health Services Research

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ObjectiveTo examine the relationship between growth in Medicare Advantage (MA) enrollment and changes in finances at skilled nursing facilities (SNFs).Data SourcesMedicare SNF cost reports, LTCFocus.org data, and county MA penetration rates.Study DesignWe used ordinary least squares regression with SNF and year fixed effects. Our primary outcomes were SNF revenues, expenses, profits, and occupancy. Our primary independent variable was the yearly county Medicare Advantage penetration.Data Collection/ExtractionWe linked facility‐year data from 2012 to 2019 obtained from cost reports and LTCFocus.org to county‐year MA penetration.Principal FindingsA 10 percentage point increase in county MA enrollment was associated with a $213,883.89 (95% Confidence Interval [CI]: −296,869.08, −130,898.71) decrease in revenue, a $132,456.19 (95% CI: −203,852.28, −61,060.10) decrease in expenses, and a 0.59 percentage point (95% CI: −0.97, −0.21) decrease in profit margin. A 10 percentage point increase in county MA enrollment was associated with a decline (−318.93; 95% CI: −468.84, −169.02) in the number of resident‐days (a measure of occupancy) as well as a decline in the revenue per resident day ($4.50; 95% CI: −6.81, −2.20), potentially because of lower prices in MA. There was also a decline in expenses per patient day (−2.35; 95% CI: −4.76, 0.05), though this was only statistically significant at the 10% level. While increased MA enrollment was associated with a substantial decline in the number of Medicare resident days (487.53; 95% CI: −588.70, −386.37), this was partially offset by an increase in other payer (e.g., private pay) resident days (285.91; 95% CI: 128.18, 443.63). Increased MA enrollment was not associated with changes in the number of Medicaid resident days or a decrease in staffing per resident day.ConclusionSNFs in counties with more MA growth had substantially greater relative declines in revenue, expenses, and profit margins. The continued growth of MA may result in significant changes in the SNF industry.

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“…Admissions to both HH agencies plummeted due to contextual factors (e.g., patient reluctance to seek or accept care in the home, and HH agency inability to accept referrals due to limited PPE access and staffing), which are important factors to address when establishing plans for preparedness in case of future public health emergencies. Decreases in service volume occurred in the larger context of increased HH substitution for SNF services during the pandemic 21 which may indicate there remained a population of older adults during the COVID‐19 pandemic who qualified for both SNF and HH services but received neither. Compared to older adults who received HH services before the pandemic, older adults transitioning home during the first year of the pandemic were more likely to be younger, African American, live with someone in their home, have around‐the‐clock assistance, have higher levels of delirium, and be receiving HH for medical (rather than surgical) reasons.…”

Section: Discussionmentioning

confidence: 99%

Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID‐19

Arbaje,

Hsu,

Zhou

et al. 2024

J American Geriatrics Society

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BackgroundSkilled home healthcare (HH) provided in‐person care to older adults during the COVID‐19 pandemic, yet little is known about the pandemic's impact on HH care transition patterns. We investigated pandemic impact on (1) HH service volume; (2) population characteristics; and (3) care transition patterns for older adults receiving HH services after hospital or skilled nursing facility (SNF) discharge.MethodsRetrospective, cohort, comparative study of recently hospitalized older adults (≥ 65 years) receiving HH services after hospital or SNF discharge at two large HH agencies in Baltimore and New York City (NYC) 1‐year pre‐ and 1‐year post‐pandemic onset. We used the Outcome and Assessment Information Set (OASIS) and service use records to examine HH utilization, patient characteristics, visit timeliness, medication issues, and 30‐day emergency department (ED) visit and rehospitalization.ResultsAcross sites, admissions to HH declined by 23% in the pandemic's first year. Compared to the year prior, older adults receiving HH services during the first year of the pandemic were more likely to be younger, have worse mental, respiratory, and functional status in some areas, and be assessed by HH providers as having higher risk of rehospitalization. Thirty‐day rehospitalization rates were lower during the first year of the pandemic. COVID‐positive HH patients had lower odds of 30‐day ED visit or rehospitalization. At the NYC site, extended duration between discharge and first HH visit was associated with reduced 30‐day ED visit or rehospitalization.ConclusionsHH patient characteristics and utilization were distinct in Baltimore versus NYC in the initial year of the COVID‐19 pandemic. Study findings suggest some older adults who needed HH may not have received it, since the decrease in HH services occurred as SNF use decreased nationally. Findings demonstrate the importance of understanding HH agency responsiveness during public health emergencies to ensure older adults' access to care.

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Post‐hospital home health use increased for non‐COVID Medicare patients during COVID‐19, particularly among complex cases

Cited by 4 publications

References 2 publications

Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals

Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals

Medicare Advantage growth and skilled nursing facility finances

Characterizing changes to older adults' care transition patterns from hospital to home care in the initial year of COVID‐19

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