Post-Acute Care Admissions Among Medicare Beneficiaries With Disabilities During Payment Reform and the COVID-19 Pandemic

Abstract

Background and objectives: Recent Medicare payment reforms aimed to improve post-acute access to skilled nursing facilities (SNFs) and home health agencies (HHAs) for patients with complex care needs, including beneficiaries with disabilities. Soon after reforms were implemented, the Coronavirus disease (COVID-19) pandemic began, which disproportionately affected older adults and people with disabilities. Leveraging Medicare administrative data to identify 2 distinct cohorts of beneficiaries with disabilities, this study explored changes in their SNF and HHA admission patterns during payment reform and COVID-19.

Research design and methods: Secondary analysis of 2018-2021 Medicare administrative data for 2 cohorts of fee-for-service beneficiaries with disabilities: (a) enrollees with disability as the reason for original entitlement (OE) and (b) enrollees qualifying based on age who have disabling conditions and/or mobility impairments (C&I). Adjusted linear mixed-effects models with interaction terms for disability cohort estimated whether differences in SNF and HHA admissions following hospitalization varied over time by disability cohort.

Results: For 7,732,989 hospitalizations in the OE cohort and 7,028,195 hospitalizations in the C&I cohort, SNF admissions decreased over time, whereas HHA admissions increased. Compared with the C&I cohort, the OE cohort experienced lower SNF admissions throughout the study and smaller changes in SNF and HHA admissions.

Discussion and implications: Both disability cohorts experienced decreased SNF and increased HHA admissions following payment reform and COVID-19. The magnitudes of changes differed between the disability cohorts. These results highlight the heterogeneity in healthcare experiences across disability cohorts and the importance of including multiple definitions of disability in research using administrative datasets.

Keywords: COVID-19; Disabled persons; Healthcare reform; Home care services; Skilled nursing facilities.