To examine the effect of the COVID-19 pandemic on post-acute care utilization and spending.
We used a large national multi-payer claims dataset from January 2019 through October 2020 to examine trends in post-hospital-discharge location and spending
We identified and included 975,179 hospital discharges who were 65 years or older.
We summarized post-discharge utilization and spending in each month of the study: (1) the percentage of patients discharged from the hospital to home for selfcare and to the three 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 three post-acute care settings.
The percentage of patients discharged from the hospital to home or to inpatient rehabilitation did not meaningfully change during the pandemic while 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 three 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% while the percentage of post-acute care spending on home health and inpatient rehabilitation both increased.
Fewer patients were discharged to post-acute care during the pandemic, with the largest and most persistent declines in discharge to skilled nursing facilities and more patients going home.
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