WellSky recently hosted a webinar with Tom Martin, director of post-acute care analytics at CarePort and Teresa Remy, director of clinical services at LeaderStat. Highlighting CarePort data, Tom reviewed the impact of the COVID-19 pandemic on the acute and post-acute settings – including inpatient volumes, post-acute referral patterns, and patient profiles at the post-acute level of care.
The acute setting
During the first COVID-19 wave in the U.S. in March-April 2020, 20% of CarePort hospital customer inpatient stays had a COVID-19 diagnosis. As hospitals nationwide faced challenges associated with an influx of COVID-19 patients, these acute care settings experienced a 30% decrease in inpatient volume, and an influx of COVID-19 patients. Hospitals made room for COVID-19 patients, halted elective surgeries, and shut down various units, resulting in fewer referrals to post-acute care.
The second wave of COVID-19 in the summer of 2020 didn’t result in the same dramatic drop in inpatient volume that occurred in April 2020. As the U.S. continues to struggle with new COVID-19 hospitalizations we will have to wait and see how hospitals respond – and whether post-acute referrals are impacted once again.
The post-acute setting
At the onset of the pandemic in the U.S. – when hospital inpatient volume decreased – post-acute referrals also experienced a significant decline: SNF referrals declined by 40%; home health referrals by 30%; and hospice referrals by ~25%. Home health referral volumes returned to normal levels by July 2020; in fact, by March 2021, referrals reached 116% of 2019 totals. However, there hasn’t been the same strength in recovery for SNF referrals, and as of May 2021 referrals to the SNF setting still hadn’t reached 2019 levels. Despite a small uptick in referrals in June and July 2021, whether the SNF industry will make a full recovery remains to be seen.
This notable shift in post-acute care delivery begs the question, “have patients and their needs changed?”. While there’s been a return to normalcy in inpatient volume, discharge patterns to post-acute care have shifted – and in reviewing data from one CarePort customer health system, it’s evident that it’s not the patients but the decision-making process regarding to where patients are discharged that’s changed. A major reason for this is due to the fact that patients and their families continue to favor home-based post-acute care; in December 2020, of the 200 patients discharged at this health system, only 38% of patients were sent to a nursing home.
Increased patient acuity in post-acute settings
CarePort data shows that the average patient discharged to a SNF is now more acute than in 2019, indicating that – despite the SNF referral and occupancy challenges spurred by the pandemic – institutional care will remain an integral part of a patient’s care journey. Data also shows the following:
Shorter hospital stays: A SNF patient’s average hospital length of stay is one-half day shorter than in 2019.
Increased comorbidity: The average comorbidity score of a SNF patient has increased by nine percent since 2019.
Fewer elective surgery patients: There has been a 15% decrease in SNF patients that fall under the diagnostic category of “Musculoskeletal System & Connective Tissue,” indicating that patients who undergo elective surgery for broken bones or joint replacements are now less likely to recover in a SNF.
What do home health patients look like as compared to SNF patients? Based on CarePort data, home health patients normally have a shorter length of stay (4.4 days) than patients that go to a SNF (6.5 days) and are, on average, seven years younger than SNF patients. SNF patients also typically have a higher average comorbidity score than home health patients. However, as home health providers face increased referral volumes, they’re also tasked with treating higher acuity patients as more chronically ill patients opt for home-based care. CarePort data highlights this trend, showing a nine percent increase in hospital average length of stay prior to discharge to home health, and a seven percent increase in home health patient acuity from 2019 to 2020.
As higher acuity patients opt for home-based care, providers need the tools in place to successfully monitor and manage patients. For example, one key home health agency measure is timeliness to start of care, and CarePort data shows that the risk of readmission rises by 3% each day a patient is not seen by a home health provider. To mitigate these gaps in care and avoid hospital readmissions, CarePort helps home health providers achieve operational effectiveness and serve as a better referral partner for hospitals, physician groups, and ACOs – particularly in the absence of on-site home health liaisons in hospitals, face-to-face interactions, and traditional “warm” handoffs.
Stay tuned for our next blog post for insights from LeaderStat’s Teresa Remy. The blog will discuss best practices for caring for patients with higher acuity, issues arising as a result of the COVID-19 pandemic (e.g. workforce shortages), and strategies for using data to market long-term care to referrals and community members.