Image of Tamara Konetzka, Ph.D., of the University of Chicago
Tamara Konetzka, Ph.D., of the University of Chicago

Admission trends in nursing homes that specialize in post-acute care may be benefitting the facilities financially, but are also leaving some patient groups out of the picture, according to a new study.

Investigators measured post-acute care specialization as annual fee-for-service Medicare admissions per bed in all U.S. nursing homes between 2001 and 2017. They found a relative increase in these admissions of 41% during this period, reported lead study author R. Tamara Konetzka, Ph.D., of the University of Chicago.

New nursing homes (opened after 2001) accounted for the greatest rise in admitted FFS patients — by 68%. In contrast, nursing homes that closed during the study period had “no meaningful growth” in Medicare admissions per bed, she and her colleagues noted.

The researchers also found an association between facilities that offered highly specialized post-acute services and Medicare admissions growth during the study period. Those in the 95th percentile of specialization, for example, saw 66% growth in Medicare admissions per bed. 

When Konetzka and colleagues examined characteristics of patients admitted and type of facility, a pattern emerged. Facilities delivering the most post-acute care were more highly staffed and more likely to be for-profit or part of a chain. They also were less likely to admit patients who were Black, Hispanic, or dually enrolled in Medicare and Medicaid.

“Although these nursing homes may benefit financially from higher Medicare payment, it may come at the expense of equitable access and patient care,” the authors concluded.

The study was published in JAMDA.