Stays at skilled nursing facilities without a prior hospital stay increased dramatically during the pandemic, but patient care costs did not see a major increase.
That’s according to a new study published in the Journal of the American Medical Association (JAMA). The study also found that SNF stays were linked with “potentially” faster discharge for some patients during the pandemic period.
Skilled nursing facility stays without prior hospitalization increased from 6% to 32% during the pandemic, but once the Covid threat became low in 2021, there was a significant reduction in waiver applications in April 2021, the study noted.
JAMA’s cohort study used 100% fee-for-service SNF and inpatient claims files for Medicare beneficiaries from January 1, 2017, to December 31, 2021, to identify SNF care stays and prior acute care.
“Although the effect of the waiver cannot be differentiated from that of the pandemic, overall SNF care costs did not increase substantially, and for [long-term care] residents, the waiver was applied primarily for Covid-19 care, suggesting its successful implementation,” the researchers noted.
The use of the pandemic-era waiver – set to expire on May 11 – may have allowed patients to avail themselves of a broader range of clinical services on site, resulting in lower costs. The waiver, in essence, may have “effectively substituted for a higher-cost hospitalization,” researchers said.
Overall spending on SNF stays did not change significantly during the pandemic, with the average monthly Medicare Part A spending on SNF-related stays being $2.1 billion before the public health emergency (PHE) and $2 billion during the PHE.
Moreover, Medicare spending for hospitalizations among long-term care residents stayed relatively stable during the PHE.
Researchers also concluded that long-term care residents receiving skilling in place ended up spending fewer days in care with fewer complications, writing, “SNFs likely triaged residents with less severe illness to receive direct SNF care rather than a hospital visit.”
However, the authors were also careful to note the study’s limitations.
“The complex epidemiological, behavioral, and health care system changes accompanying the early COVID-19 pandemic make it difficult to isolate the effects of the PHE waiver on the care patterns and outcomes of SNF care beneficiaries,” researchers wrote. “However, the waiver was not associated with a substantial increase in the overall SNF care volume and was applied for LTC residents primarily for COVID-19 care, suggesting that the goals for the waiver were successfully achieved.”
Direct admittance into a nursing home jumped especially during the first year of the pandemic, and the 3-day stay waiver was used primarily among certain types of facilities and for long-term residents with Covid, the authors of the study said.
Skilled nursing providers have spoken out on the need to permanently end the 3-day stay requirement, and have expressed hopefulness that data from the waiver period will support this outcome.
“After 58 years of this rule, it is time for this to go away,” Kathy Gallin, vice president of legislative affairs and health policy at Signature HealthCARE, said at the recent Skilled Nursing News CLINICAL conference in Washington, D.C.