Trends in Post-Acute Care Utilization During the COVID-19 Pandemic

Abstract

Objective: To examine the effect of the COVID-19 pandemic on post-acute care utilization and spending.

Design: We used a large national multipayer claims data set from January 2019 through October 2020 to examine trends in posthospital discharge location and spending.

Setting and participants: We identified and included 975,179 hospital discharges who were aged ≥65 years.

Methods: We summarized postdischarge utilization and spending in each month of the study: (1) the percentage of patients discharged from the hospital to home for self-care and to the 3 common post-acute care locations: home with home health, skilled nursing facility (SNF), and inpatient rehabilitation; (2) the rate of discharge to each location per 100,000 insured members in our cohort; (3) the total amount spent per month in each post-acute care location; and (4) the percentage of spending in each post-acute care location out of the total spending across the 3 post-acute care settings.

Results: The percentage of patients discharged from the hospital to home or to inpatient rehabilitation did not meaningfully change during the pandemic whereas the percentage discharged to SNF declined from 19% of discharges in 2019 to 14% by October 2020. Total monthly spending declined in each of the 3 post-acute care locations, with the largest relative decline in SNFs of 55%, from an average of $42 million per month in 2019 to $19 million in October 2020. Declines in total monthly spending were smaller in home health (a 41% decline) and inpatient rehabilitation (a 32% decline). As a percentage of all post-acute care spending, spending on SNFs declined from 39% to 31%, whereas the percentage of post-acute care spending on home health and inpatient rehabilitation both increased.

Conclusions and implications: Changes in posthospital discharge location of care represent a significant shift in post-acute care utilization, which persisted 9 months into the pandemic. These shifts could have profound implications on the future of post-acute care.

Keywords: COVID-19; Post-acute care.

Fig. 1

Trends in destination after hospital discharge to the 4 most common discharge destinations (home with self-care, skilled nursing facility, home with home health, and inpatient rehabilitation). (A) Percentage of all hospital discharges. (B) Rate per 100,000 insured members.

Fig. 2

Trends in spending on the 3 most common settings for formal post-acute care. The trend lines display the total monthly spending in each setting. The stacked bars display the monthly spending in each of these 3 settings as a percentage of total spending across these 3 post-acute care settings. HH, home with home health; IRF, inpatient rehabilitation; SNF, skilled nursing facility.