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COVID-19: The New Normal for Acute and Post-Acute Care

CarePort has been closely examining its data across an extensive network of over 1,000 hospitals and more than 110,000 post-acute providers over the past several months of the COVID-19 pandemic, searching for insights that are most helpful to customers. On two recent webinars, we discussed the impact of COVID-19 on hospital readmissions, and its effect on value-based programs, as well as the impact of COVID-19 on acute to post-acute transitions. Here are the highlights:

Significant impact on hospital inpatient volumes

Unsurprisingly, we have seen dramatic changes in hospital inpatient volumes during the COVID-19 pandemic. In March, CarePort customers’ inpatient volumes dropped by 30%*. Interestingly, when these trends are broken down by geography, CarePort data shows a similar dip and recovery across the US, despite the pandemic affecting different regions of the country at different times, and with varying severity. Beginning in May, inpatient volumes began to return to normal levels – and though numbers are still not where they were prior to the pandemic, CarePort data shows that hospitals reached inpatient volumes of 80% in July.

Changes in referral patterns

Right after hospital inpatient volumes took a dramatic dive, CarePort saw that trend play out in referral volume for its CarePort Care Management customers. Examining data across Care Management hospitals – which regularly send referrals to post-acute providers including skilled nursing facilities and home health – there was a significant dip in the number of post-acute referrals during the COVID-19 pandemic. During this time, patients with a home health referral dropped 32 percentage points; patients with a SNF referral dropped 34 points.

Despite a craterous dip for home health in April, referral volumes to home health were restored to normal levels by July. However, data shows that there is not the same strength in recovery for SNF referrals. The SNF industry has been disproportionately impacted during the pandemic, as these providers care for the most vulnerable of patients. As of July, SNF referrals were still down 25 percentage points.

With a slow recovery for skilled nursing comes uncertainty in how care will be delivered moving forward. For example, what are the consequences for patients that would be referred to SNFs but are instead being sent home? Will this change – long-term – how referrals are handled?

According to CarePort data, 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%. CarePort will continue to monitor these patterns, and what they mean for readmission rates, cost of care and quality of care in the future.

Noteworthy shift in the types of patients seeking hospital care

CarePort data also shows a shift in the type of patient that is seeking hospital care during the COVID-19 pandemic. CarePort typically categorizes patients based on major diagnostic categories (MDCs), as defined by CMS. MDCs group patients into certain groupings based on their primary diagnoses. When examining the distribution of patients by their MDCs  during the COVID-19 pandemic, the typical primary diagnosis codes for patients seeking hospital care experienced a notable shift. Unsurprisingly, the MDCs experiencing increased inpatient stays were diagnoses associated with the COVID-19 patient population. For example, data shows an increase in inpatient stays where the primary diagnosis indicated something wrong with the lungs (a breathing problem or respiratory issue), or an infection. Essentially, more patients were admitted under primary diagnosis code U07.1, the MDC now being used to represent the COVID-19 population. This represents a significant shift in the type of patient seeking hospital care; MDCs are typically very stable, and so these patient mix changes are meaningful. On the other hand, other MDCs experienced decreased inpatient stays – including disorders of musculoskeletal system and connective tissue – as joint replacement and elective surgeries decreased.

 

Stay tuned for a future blog post, which will examine the impact of COVID-19 on hospital readmissions, as well as the impact of COVID-19 on transitions from acute to post-acute care.

 

*Though this can look very different for individual hospitals, 30% is the average drop in inpatient volumes according to CarePort data.

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