Medicare payment reforms and COVID-19 reshape post-acute care for people with disabilities

A recent study, led by Assistant Professor Rachel Prusynski, DPT, PhD, examines how Medicare payment reforms and the COVID-19 pandemic impacted post-acute care for beneficiaries with disabilities. Published in The Gerontologist as part of a special issue on Aging & Disability, the study uses Medicare data from 2018 to 2021 to explore differences in care settings for two distinct disability cohorts. 

The research took a novel approach, defining disability either traditionally—based on Supplemental Security Income (SSI) eligibility—or by identifying chronic and disabling conditions through administrative data. Examining the data for these two distinct groups revealed significant differences in post-acute care patterns.

Both cohorts experienced decreased admissions to skilled nursing facilities (SNFs) and increased admissions to home health agencies (HHAs) during the study period. However, beneficiaries qualifying for Medicare due to disability had consistently lower SNF admissions and smaller shifts in care patterns compared to older adults with disabling conditions or mobility impairments.

The findings suggest that Medicare’s payment reforms and the pandemic had varying impacts on different groups. This illustrates the importance of considering multiple definitions of disability in research to better understand and address the needs of diverse populations.

The study team included Dr. Prusynski, Andrew Humbert, PhD, Cait Brown, MA, CCC-SLP, and Tracy M. Mroz, PhD, OTR/L, from our department, as well as colleagues from other University of Washington departments and other institutions. Dr. Mroz served as the principal investigator for the National Institute on Aging (NIA) grant that funded this research.