The Covid-19 pandemic has magnified critical issues in the United States healthcare system, and has made significant, potentially long-lasting impacts on care transitions, referral patterns and care delivery across the acute and post-acute settings. In what may be our new normal at the post-acute level, many hospitals, patients and families continue to opt for in-home care over institutional care settings such as skilled nursing facilities (SNFs). This marked shift in care delivery preferences can be explained by several factors, whether it’s a patient or family’s fear surrounding SNF stays during the Covid-19 pandemic, families that worry they will be restricted from visiting a patient in a SNF, or people that are simply able to take on caregiving responsibilities while working from home or unemployed. But what exactly led us to this point, and will this marked shift in how care is delivered last beyond the pandemic?
Impact on Hospital Inpatient Volumes
To understand what happened at the post-acute level, we should first examine what happened at the acute level. Unsurprisingly, the Covid-19 pandemic resulted in dramatic changes in hospital inpatient volumes at the onset of the Covid-19 pandemic. Last March, hospital inpatient volumes dropped by 30% across CarePort customer hospitals. Even when broken down by geography, a similar dip and recovery can be seen across the U.S., despite the pandemic affecting different regions of the country at different times, and with varying severity. Beginning in May, inpatient volumes across hospitals – including CarePort’s customer hospitals – started to return to normal inpatient volumes, and the distribution of those patients by their primary diagnoses also returned to normal as elective surgeries resumed.
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Post-Acute Referrals Take a Hit
Following this dramatic dive in hospital inpatient volumes, the same trend played out in referral volumes to post-acute providers, including both SNFs and home health. During this time (March/April 2020), patient referrals to home health dropped 32 percentage points, while patients with a SNF referral dropped 34 points.
Despite this craterous dip for home health in April 2020, referral volumes were restored to normal levels by July 2020. In fact, home health agencies were running above their previous capacity, with referrals to the setting reaching 109% of 2019 totals by October 2020.
However, data shows that there is not the same strength in recovery for SNF referrals. Data from the Centers for Disease Control (CDC) shows that, that as of January 2021, 73% of SNFs have taken Covid-19-positive patients, 99% are reporting they have the ability to test staff and residents and 92% have all the necessary personal protective equipment (PPE) required to maintain patient and staff safety. Despite this, the SNF industry has been – and remains – disproportionately impacted during the pandemic. For CarePort customer hospitals, there has historically been a fifty-fifty split in referrals to SNFs and home health, but the pandemic has shifted these referral ratios – home health now comprises 55% of referrals, whereas SNFs lag at 45%. We also believe that occupancy rates in SNFs are also at an all-time low and despite having the beds available to take in additional patients, demand is negligible. In January of 2020, 32% of the nation’s SNF providers reported having occupancy rates greater than 90% – whereas in January 2021, only 9% of providers have reached that level of occupancy. In fact, several providers have closed their doors. Though there has been a slow and steady rate of facility closures over the last five years, in the last year alone there have been an additional 114 closures. We might expect additional closures as provider relief funds dry up.
Looking Ahead
We don’t expect to see SNF referral volumes fully recover and reach 2019 levels anytime soon, and anticipate that patients who typically would have gone to skilled nursing facilities will still go to home health for the foreseeable future. With a slow recovery for skilled nursing comes uncertainty in how care will be delivered moving forward. For example, what does this shift in care mean for readmission rates, cost of care and quality of care in the future? What are the consequences for patients that would be referred to SNFs but are instead being sent home? Will this change – long-term – be how referrals are handled? As of now, there are countless unanswerable questions regarding long-term implications of this shift to home-based care.
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Tom Martin Tom Martin is the director of post-acute care analytics at CarePort, powered by WellSky. He has led several data analytics teams providing insight to healthcare providers trying to improve quality of care for their post-acute care patients. He holds an M.S. in Resources Economics with a concentration in econometrics from the University of […]
Because patients are increasingly being discharged from hospitals to home health instead of a SNF, care coordination tools have become that much more critical to providing patients with necessary, high-quality care post-discharge. Care coordination tools can help monitor a patient’s care in their own home – whether with follow-up touchpoints or a coordinated treatment plan. For example, a patient’s first home health visit should be tracked, and providers must also ensure that the patient follows his or her medication instructions while at home and schedules the necessary telehealth or in-person appointments.
As we look at the year ahead, we expect these trends to continue. Covid-19 has highlighted the critical importance of increased communication and transparency between acute and post-acute providers, and the immediate need for more diverse acute and post-acute care options. The pandemic has also left its mark on care delivery – increasing our reliance on home care, neglecting institutional care facilities, and spurring a demand for post-discharge care coordination tools as payers and providers adapt to meet patients’ needs across the continuum. Whether the scars on the SNF industry are permanent, however, remains to be seen.
Data reported here is based on data from CarePort customer hospitals and may not be representative of the nation at large.
Photo: SDI Productions, Getty Images
Tom Martin is the director of post-acute care analytics at CarePort, powered by WellSky. He has led several data analytics teams providing insight to healthcare providers trying to improve quality of care for their post-acute care patients. He holds an M.S. in Resources Economics with a concentration in econometrics from the University of Massachusetts Amherst. As director of post-acute care analytics at CarePort, Tom studies how the ever-changing PAC regulatory and payment landscape is impacting care delivery and how acute and post-acute providers can leverage their data to improve patient care.
