Image of Rachel M. Werner, M.D., Ph.D.; Image credit: University of Pennsylvania
Rachel M. Werner, M.D., Ph.D.; Image credit: University of Pennsylvania

The pandemic has hastened a decline in post-acute discharges to skilled nursing facilities, a new study of commercially insured patients has found.

Discharges to SNFs decreased 5%, while total monthly spending in these facilities fell by 55% between January 2019 and October 2020, according to physician researchers from the University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center in Philadelphia.

Discharges from hospital to home or to inpatient rehabilitation did not change significantly during the study period, but the percentage of patients transferred to an SNF declined from 19% of discharges in 2019 to 14% by October 2020. 

In addition, total monthly spending dropped across all three discharge settings studied: to home with home health, to SNFs, and inpatient rehabilitation. SNFs had the largest relative decline, falling from an average of $42 million per month in 2019 to $19 million in October 2020, reported Rachel M. Werner, M.D., Ph.D., and Eric Bressman, M.D.

Concerns about transmission of COVID-19 are likely behind much of this additional pandemic decline in the use of SNFs, according to the authors. But these settings have been a common target of alternative payment models implemented over the past decade by Medicare and other insurers, making home health a growing choice for post-acute care before the SARS-CoV-2 virus arrived, they said. 

Whether these trends continue after the pandemic remains to be seen, but they could have profound implications for the future of post-acute care, Werner and Bressman said.

The shift away from skilled nursing care may leave recovering patients without necessary skilled short-term help with activities of daily living. And existing models of home-based care may not include sufficient medical care, leading to worse outcomes for some patients, they authors contended.

A continued decrease in the use of SNFs for post-acute care may also speed the decline of nursing homes overall by reducing a financially important source of revenue for these operations, they added.

“These trends may also hasten a reckoning with the instability of the nation’s nursing homes and their current inadequate financing,” they concluded.

Full findings were published in the December issue of JAMDA.