Impact of Payment Reform and COVID-19 on Post-Acute Care for Older Adults with Disabilities
Author Information
Author(s): Rachel Prusynski, Natalie Leland, Andrew Humbert, Arati Dahal, Cait Brown, Harsha Amaravadi, Tracy Mroz
Hypothesis
Did recent Medicare payment reforms improve access to post-acute care for older adults with disabilities?
Conclusion
The study found that while PDPM worsened access to skilled nursing facilities for beneficiaries with disabilities, access rebounded after COVID-19 vaccinations, and PDGM improved access to home health agencies.
Supporting Evidence
- Before reforms, 11.1% of beneficiaries with disabilities were discharged to skilled nursing facilities (SNFs) and 13.1% to home health agencies (HHAs).
- PDPM was associated with a 0.43-percentage point decline for SNF discharges.
- PDGM was associated with increases in HHA (1.91pp) and SNF (0.37pp) discharges until the COVID-19 pandemic.
- HHA discharges remained high at an average of 18.4% after vaccination efforts.
- SNF discharges increased to 14.3% of all hospital discharges after vaccination efforts.
Takeaway
The new payment rules for Medicare aimed to help older adults with disabilities get better care, but some changes made it harder for them to go to nursing homes until after they got vaccinated.
Methodology
An interrupted time series analysis of Medicare hospitalizations from 2018-2021 was conducted.
Participant Demographics
Beneficiaries with disabilities as the original reason for Medicare entitlement.
Digital Object Identifier (DOI)
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