MA, Traditional Medicare Differences in Inpatient Rehabilitation Narrowed During the Pandemic

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Research has shown that Medicare beneficiaries enrolled in Medicare Advantage (MA) plans tend to use fewer post-acute services than those who in traditional Medicare. Studies found that people in MA plans have shorter lengths of stay than those in traditional Medicare and were less likely to receive care at facilities rated as delivering high-quality. The reason for these patterns is debatable and the type of MA plan (preferred provider organization compared with health maintenance organization) is a factor, but the fact that MA plans are paid a risk-adjusted capitated payment is presumed to be a factor.

The COVID-19 pandemic scrambled U.S. healthcare delivery in dozens of ways, and post-acute care especially. Particularly early in the pandemic, hospitals shortened length of stays. Because Fear of infection and dire outcomes from COVID-19 meant patients that might have been discharged to skilled nursing facilities received care at home instead.

Ying (Jessica) Cao, Ph.D., examined inpatient rehabilitation facility usage and cost before and after the COVID-19 pandemic.

Ying (Jessica) Cao, Ph.D., an assistant professor of population health sciences at the University of Wisconsin School of Medicine and Public Health, and her colleague, Dian Luo, M.S., set out to study how COVID-19 affected post-acute care in a more systemic way and particularly whether there were major changes in the pre-pandemic differences between post-acute are for those in MA plans and traditional Medicare. They reported the results of their research recently in the Journal of the American Medical Directors Association.

Cao and Luo used data from the Inpatient Rehabilitation Facility-Patient Assessment Instrument to conduct their study, which spanned from Jan 2019 through December 2020. The COVID-19 pandemic was declared a public health emergency on Jan. 31, 2020. Their study comprised just over 270,000 patient episodes over the 24 months of 2019 and 2020 related to stroke (138,277 episodes), fractures (68,488), hip or joint replacement (19,020), a cardiac event (35,334) or a pulmonary one (10,069).

Dian Luo, M.S., collaborated with Cao on a study of inpatient rehabilitation facilties usage and cost before and after the pandemic.

For the purposes of this study, Cao and Luo defined the prepandemic period as extending from January 2019 through February 2020 and the pandemic period from March 2020 through December 2020.

Not surprisingly, the University of Wisconsin researchers found that admissions to inpatient rehabilitation facilities overall declined sharply during the first three month of the pandemic, although they increased slightly (6%) for fractures. By the end of 2020, however, admissions bounced and were only slightly lower.

Before any kind of risk adjustment, the length of stay was longer during the pandemic months than the prepandemic period, but patients admitted during the pandemic were more likely to have comorbidities. After making statistical adjustments for patient and facility characteristics, Cao and Luo’s found that length of stay were shorter during the pandemic.

Before the pandemic and without any kind of statistical risk adjustment, more than 20% of patients were discharged from inpatient rehabilitation facilities to home without outside help and about 50% to home with assistance from a home health agency, according to Cao and Luo’s findings. The remainder were discharged to long-term care hospitals, hospice and other facilities. During the pandemic — and, again, this is no surprise — there more substantially more discharges to home with help from a home health agency and fewer to skilled nursing facilities and home without support from a home health service.

When Cao and Luo compared patients enrolled in MA plans to those in traditional Medicare, prepandemic and pandemic, they found that the differences prepandemic got smaller during the pandemic. For example, they found that prepandemic, beneficiaries in MA plans had longer lengths of stay for all the conditions except fracture. During the pandemic months of 2020, there was no real difference between the MA beneficiaries and those in traditional Medicare when it came to length of stay.

Before the pandemic, the payment per episode for MA beneficiaries was lower than it was for patients in traditional Medicare (-$361) and more discharges home without help from a home health agency. During the pandemic, the payment per episode for both MA and traditional Medicare patients went up(+$798) but the differences between MA and the traditional Medicare patients narrowed.

“By the end of 2020, the differences between TM (traditional Medicare) and MA in LOS (length of stay), payment per episode and discharge patterns were small than those in 2019,” Cao and Luo concluded.