Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic

Anthony I Roberts; Christopher M Santostefano; Zihan Chen; Brian E McGarry; Elizabeth M White; Linda J Resnik; Fangli Geng; David C Grabowski; Momotazur Rahman

doi:10.1093/haschl/qxaf056

Trends in hospital discharge outcomes among high-risk Medicare beneficiaries before and during the COVID-19 pandemic

Health Aff Sch. 2025 Mar 18;3(4):qxaf056. doi: 10.1093/haschl/qxaf056. eCollection 2025 Apr.

Authors

Anthony I Roberts¹, Christopher M Santostefano¹, Zihan Chen¹, Brian E McGarry², Elizabeth M White¹, Linda J Resnik¹, Fangli Geng¹, David C Grabowski³, Momotazur Rahman¹

Affiliations

¹ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI 02903, United States.
² Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY 14642, United States.
³ Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, United States.

Abstract

Introduction: Medicare beneficiaries face significant health risks and care disruptions during public health emergencies, but little is known about how care patterns evolved throughout the COVID-19 pandemic or differed between traditional Medicare (TM) and Medicare Advantage (MA).

Methods: Using Medicare claims data for over 20 million hospital discharges during 2018-2022, we examined trends in hospital length of stay, discharge disposition, and mortality among beneficiaries with 5 major comorbidities (dementia, diabetes, congestive heart failure, hip fracture, and stroke), stratified by COVID status and payer type.

Results: We found that COVID patients initially experienced substantially longer hospital stays (8.3 vs 4.6 days) and higher 30-day mortality (34% vs 5%) compared to patients without COVID. MA beneficiaries showed consistently higher home health utilization but similar mortality patterns to TM enrollees. By mid-2022, most outcome differences had converged between COVID and non-COVID patients, suggesting health system adaptation to the pandemic.

Conclusion: Our findings highlight how the pandemic was associated with shifts toward home-based post-acute care, emphasizing the need for policies supporting home-based care infrastructure and flexible care delivery models that could help health systems better adapt during future public health emergencies.

Keywords: COVID-19; Medicare; Medicare Advantage; Traditional Medicare; comorbidities; home health care; hospital discharge outcomes; length of stay; mortality; post-acute care; skilled nursing facilities.