Postacute Care, Medicare Admission Rate Trends in US Nursing Homes

Authors of a retrospective cohort study looked at US nursing homes (NHs) and all fee-for-service Medicare admissions to nursing homes for postacute care between 2001 and 2017 and determined that while these facilities may benefit from increased Medicare payment, access and patient care may be affected.  

Postacute care specialization was measured as annual Medicare admissions per bed for each NH and researchers examined changes in the distribution of specialization across NHs over the study period. NH characteristics were described according to the degree of specialization of care provided to the patients.

According to results, the average number of Medicare admissions per bed increased from 1.2 to 1.6 from 2001 to 2017, respectively—a relative increase of 41%.

“This upward trend in the number of Medicare admissions per bed was largest among new NHs (those established after 2001), increasing 68% from 2001 to 2017,” stated study authors. “In contrast, NHs that eventually closed during the study period experienced no meaningful growth in the number of admissions per bed.”

Results also showed “the number of Medicare admissions per bed grew by 66% at the 95th percentile and by 25% at the 99th percentile. NHs delivering the most postacute care were more likely to be for-profit or part of a chain, had higher staffing levels, and were less likely to admit patients who were Black, Hispanic, or dually enrolled in Medicare and Medicaid.”

“Over the last 2 decades, postacute care has become increasingly concentrated in a subset of NHs, which tend to be for-profit, part of a chain, and less likely to serve racial and ethnic minorities and persons on Medicaid,” found the study authors.

The observed trends prompted the authors to conclude that while increased Medicare admissions may provide financial benefit to NHs, these facilities run the risk of reducing equitable access to care for the patient populations.

Reference:
Werner RM, Templeton Z, Apathy N, Skira MM, Konetzka RM. Trends in post-acute care in US nursing homes: 2001-2017. J Am Med Dir Assoc. 2021; 12(22):2491-2495.E2. doi:10.1016/j.jamda.2021.06.015