Skilled nursing facilities consistently received a higher share of hospital discharges compared to home health care agencies towards the last quarter of 2021 and beginning of the first quarter of 2022, a shift from the home health trend in the early days of the pandemic.
“There was a preference amongst just about everybody to send them home instead of to a nursing home, wherever feasible, so that’s what caused that initial flip early in 2020,” Fred Bentley, managing director of the Washington, D.C.-based advisory and research firm ATI Advisory.
In this period, between November 2021 and February 2022, discharge numbers returned closer to pre-pandemic levels, according to a new data analysis conducted by ATI Advisory. The analysis took into account Medicare fee-for-service patients from January 2019 to February 2022, and paid through March 2022.
SNF discharge normalization was expected by most in the post-acute space, even during the height of COVID-19. After all, some patients’ acuity levels are too high to be cared for in the home.
While home health care gained a greater share of post-acute referrals compared to skilled nursing facilities (SNFs) early on in the pandemic, there’s been normalization since then, according to the ATI analysis.
“We’ve gotten the virus under control, hospitalization rates, actual infection rates, mortality rates have all, thankfully, plummeted,” ATI’s Bentley said. “And so we are seeing a return to normal to a certain extent.”
After the public health emergency was declared in March of 2020, hospital discharges bottomed out the following month. While they ticked back up in 2021 and 2022, they still remain 25% lower than they were in February of 2020.
SNF discharges dropped by 2% year over year from 2020 to 2021, and they ticked up by 1.2% from February 2021 to 2022, the largest gain of any post-acute setting. Meanwhile, home health agencies’ share of discharges dropped by 1.7% from February 2021 to February 2022.
Overall, from March 2020 to February 2022, home health agencies scored 18% of hospital discharges. For COVID-19 patients, that number fell to 14%. Meanwhile, SNF share was at 16% and 18%, respectively.
SNF discharge normalization was expected by most in the post-acute space, even during the height of COVID-19. After all, some patients’ acuity levels are too high to be cared for in the home.
More SNF-at-home and even hospital-at-home programs could change that, but in all likelihood, that would be much further down the line.
Plus, despite the Medicare fee-for-service data displayed, there are still signs to suggest that home health referrals are much higher overall than they were prior to the pandemic.
Even if demand for home health services is increasing, that demand coming to fruition for agencies’ bottom lines is all based on staffing capacity. In January 2022, the industry’s referral rejection rate had reached 58%, according to WellSky.
“This is telling us that [providers] can’t take this high volume of patients looking for home health services, and they’re starting to turn down more and more patients from their referral partners,” Tom Martin, director of post-acute care analytics at WellSky, told Home Health Care News at the time.
(Additional reporting contributed by Shelby Grebbin.)
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