Presentation Recap: Quantifying COVID’s Disruption on SNF Care

People who care about quality and how to pay for it are interested in what happened at Skilled Nursing Facilities (SNF) during the pandemic’s early days.

After all, SNF are where some of the sickest and most of the expensive patients receive care. Post-acute care, which often occurs at SNF, is a hotbed of quality improvement and payment innovation. And COVID-19 was the biggest stress test the modern health care system has ever faced.

COVID-19 Disrupted Skilled Nursing Facility Utilization and Outcomes across Medicare Advantage Enrollee Subgroups, a new study led by NCQA Research Scientist Rachel Harrington, explores what happened at SNF during the first months of the pandemic.

Rachel and her two co-authors compared SNF discharges of Medicare Advantage patients from January through June 2020 to discharges the same period a year earlier.

COVID-19 Disrupted Skilled Nursing Facility Utilization and Outcomes across Medicare Advantage Enrollee Subgroups

Discharges decreased 21 percent, from 78,012 in 2019 to 61,854 in 2020. The drop started in March—the month widespread lockdowns started and the pandemic began dominating public awareness. The decrease was largest in May, when discharges declined 47 percent year-over-year, from 13,399 to 7,091.

The number of discharges wasn’t the only thing that changed. Discharge status shifted, too. In April 2020, for example, the percentage of people who were deceased when they were discharged more than doubled to 7.5 percent. While the effects were felt across different ages, men and women, and in both dual-enrolled and non-dual-enrolled groups, the largest and most sustained changes were observed among the oldest. People 85 and older saw the greatest increase in death at discharge and the greatest decrease in return to hospitals within 30 days of discharge.

The study notes “competing pressures on different aspects of SNF-related utilization, including tendency to admit, discharge and readmit.” The authors conclude, “Results of this study begin to inform interpretation of quality results during the pandemic.”

To learn more, see the poster for COVID-19 Disrupted Skilled Nursing Facility Utilization and Outcomes across Medicare Advantage Enrollee Subgroups.

This study was one four reports NCQA staff presented at the AcademyHealth Annual Research Meeting on June 15, 2021. Others were:

The primary source of funding for this study was self-funded, NCQA.