Medicare Fee-for-Service, or traditional Medicare, admissions to nursing homes decreased significantly year over year by almost 20% in the fourth quarter of 2023.

Coupled with this drop is a steady rise in Medicare Advantage enrollment, with such plans representing 54.7% of all beneficiaries enrolled in both Medicare Part A and B as of February, Trella Health reported in a recent quarterly trends update. MA enrollment jumped 2% from 2023 to 2024, and rose 18% from 2017.

Traditional Medicare decline is different compared to what Trella reported in its 2023 edition of its Post-Acute Care Industry Trend Report, which found that the year-over year national FFS skilled nursing admission increased by 5.8% in 2022 Q3, 4.1% in 2022 Q2, and 7.9% in 2022 Q1.

Despite these increases, quarterly skilled nursing admissions decreased faster than FFS enrollment when comparing 2019 and 2022 directly, Trella reported.

“This data means the latest year-over-year increases in 2022 don’t compensate for the substantial decrease in SNF admissions amid the height of the pandemic – further illustrating the long-term impact of the COVID-19 pandemic on the SNF industry,” researchers said in the 2023 report.

FFS decreased among home health admissions as well between Q4 2022 and 2023, but only by 4.6%, while hospice admissions of traditional Medicare increased slightly during the same time period, Trella found.

The percentage of inpatient stays instructed to seek skilled nursing care, meanwhile, stayed the same between the same time period, the report found. Trella’s 2023 report found that skilled nursing utilization increased from 21.5% for the rolling four quarters ending in Q3 2021, to 22.7% ending in Q3 2022 but remained below 2019 numbers.

“The increase could also reflect the changing attitude from fears of SNFs representing COVID-19 transmission hotspots to pre-pandemic understanding of the role of skilled nursing in the overarching healthcare ecosystem,” Trella said in its 2023 report.

Interestingly, the percentage of inpatient stays told to seek out home health declined, from 23% in 4Q of 2022 to 22.5% in Q4 2023.

Those told to seek hospice from their inpatient stay also decreased slightly from 4.1% to 4% between 2022 and 2023.