A new study published in JAMA Network found that among Medicare beneficiaries eligible for post-acute care at home or in a skilled nursing facility (SNF), those who recuperated at home had a higher rate of readmission than those who went to a SNF. However, the Medicare payments were significantly lower at home.
“Use of post-acute care is common and costly in the United States, but there is significant uncertainty about whether the choice of post-acute care setting matters,” wrote the authors. “Understanding these tradeoffs is particularly important as new alternative payment models push patients toward lower-cost settings for care.”
For this cohort study, researchers looked at the Medicare claims data of more than 17 million hospitalizations from 2010 to 2016 and discovered that discharged patients who received home healthcare had a higher 30-day rate of readmission but a significantly lower Medicare payment for initial post-acute care and for the total 60-day episode of care including hospitalization, all post-acute care, and subsequent readmissions. There were no significant differences in 30-day mortality rates or improved functional status.
Discharge to home was associated with a 5.6-percentage point higher rate of readmission at 30 days compared with discharge to a SNF. Yet the Medicare payment for post-acute care was significantly lower with an average savings of $5,385 per beneficiary. The research also showed average savings of $4,514 per beneficiary within the first 60 days following hospital admission.
According to a research brief from University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI), several factors play in to why patients do better at SNFs, such as 24-hour patient monitoring and a higher level of treatment intensity, but that also costs morel.As institutional post-acute care is associated with higher Medicare payments than home healthcare. Further research may be helpful to better understand the profiles of beneficiaries that would most benefit from SNF care or who are least likely to be readmitted after discharge to home healthcare.
“Payment reform implemented after the passage of the Affordable Care Act has driven hospitals to reduce readmissions at the same time as alternative payment models have incentivized lowering costs,” said LDI. “Optimal clinical decisions will involve balancing these incentives.”
