Medicare reforms and COVID-19 shaped post-acute care trends

A new study, funded by the National Institute on Aging (NIA), examines how Medicare payment reforms and the COVID-19 pandemic impacted access to skilled nursing facilities (SNFs) and home health agencies (HHAs) for post-hospital care. The research, led by Assistant Professor Rachel A. Prusynski, DPT, PhD, and colleagues, analyzed over 31 million hospitalizations between 2018 and 2021 using 100% Medicare fee-for-service data.

The findings highlight the interconnected nature of SNFs and HHAs in post-acute care. Medicare's payment reforms—the Patient-Driven Payment Model (PDPM) for SNFs and the Patient-Driven Groupings Model (PDGM) for HHAs—were associated with increases in admissions to their respective care settings. These results suggest that concerns about reduced access under PDPM and PDGM may not apply to the overall Medicare population, though additional research is underway for specific subgroups, such as patients with disabilities.

The COVID-19 pandemic significantly accelerated existing trends. Compared to pre-pandemic levels, SNF admissions decreased by more than 19,000 patients per month, while HHA admissions increased by over 30,000 patients per month during the pandemic. This shift from institutional to home-based care reflects evolving patient preferences and pandemic-driven changes in care delivery.

These trends are expected to have long-term effects on health care systems and policy planning. 

The findings were published in the Journal of the American Geriatrics Society. 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.