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      Trends in post-acute care utilization during the COVID-19 pandemic

      brief-report

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          Abstract

          Objective

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

          Design

          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

          Setting and participants

          We identified and included 975,179 hospital discharges who were 65 years or older.

          Methods

          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.

          Results

          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.

          Conclusions and Implications

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

          Abstract

          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.

          Related collections

          Author and article information

          Journal
          J Am Med Dir Assoc
          J Am Med Dir Assoc
          Journal of the American Medical Directors Association
          Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.
          1525-8610
          1538-9375
          7 September 2021
          7 September 2021
          Affiliations
          [1 ]Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
          [2 ]Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
          [3 ]Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
          Author notes
          [] Corresponding author: Rachel M. Werner 3641 Locust Walk Philadelphia, PA 19104 215-573-5752
          Article
          S1525-8610(21)00776-3
          10.1016/j.jamda.2021.09.001
          8421095
          34555340
          d9f922e2-82fb-45d4-aa3f-1da1e3bad8d1
          © 2021 Published by Elsevier Inc. on behalf of AMDA -- The Society for Post-Acute and Long-Term Care Medicine.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 7 July 2021
          : 30 August 2021
          : 1 September 2021
          Categories
          Original Study - Brief Report

          post-acute care,covid-19
          post-acute care, covid-19

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