Did Avoiding Post-Acute Skilled Nursing Facility Care During the COVID-19 Pandemic Save Lives?

Abstract

Context: During the COVID-19 pandemic, patients using post-acute care generally avoided skilled nursing facilities, presumably to reduce their chance of illness and death. However, staying at home after an acute inpatient hospitalization carries its own risks. Objectives: To assess whether avoiding skilled nursing facilities in 2020 saved lives and whether this behavior also led to a change in readmission rates. Methods: Retrospective cohort study using Medicare Fee-for-Service medical claims data for patients in Michigan. Findings: Between 2019 and 2020, use of skilled nursing facilities fell by 8 percentage points, which was not due to a change in patient characteristics. The reduction in use of post-acute skilled nursing facility care was associated with a 23.3% lower 90-day mortality rate during the COVID-19 pandemic than otherwise expected, and 117 saved lives. There was also a small increase in the readmission rate across years. Finally, between-group disparities worsened, with the vast majority of the reduction in both mortality and readmissions seen among patients who were not dually eligible for Medicaid. Limitations: The data are limited to the state of Michigan. Implications: Findings from this study should be used to inform health professionals of the benefits and risk of post-acute care following hospitalization during times of increased disease transmission. Extra consideration should be given to the post-acute care and outcomes of dual-eligible patients.

Keywords

• skilled nursing facility
• COVID-19
• disparities
• mortality
• readmission
• Medicare