The national Medicare Advantage beneficiary admissions to nursing homes increased by 21.2% in 2021, and Medicare fee-for-service (FFS) admissions in the sector decreased by 13.8% between 2022 and 2023.

Trella Health captured this data in its post-acute care industry trend report for 2024, confirming what the industry has been saying about the rise of MA at the expense of traditional, or FFS Medicare.

“As the industry becomes increasingly complex, more data is needed to understand the full picture. We are constantly diversifying our dataset to include more payer sources and enhance insights across the care continuum,” Scott Tapp, CEO of Trella Health, said in an introductory note for the company’s 2024 report.

Increased access to MA data in particular will fuel meaningful insights well into the future, he said.

“The long-term trajectory for Medicare Advantage skilled nursing admissions is more difficult to ascertain due to the available time frame being considerably impacted by the COVID-19 pandemic,” researchers said.

Medicare FFS enrollment decreased by 3.6% in 2023, a continued decrease with 2022 seeing a 3.9% drop and 2021 experiencing a 4.4% drop among nursing homes.

The increase in MA was seen compared to a “relatively deflated” 2020 level, due to pandemic lockdowns, the report found. FFS admissions decline was driven by “substantial quarterly shifts between Q3 and Q4 of 2023.

In terms of skilled nursing FFS utilization, the national average remained stable in 2023 at 22.7%, compared to 22.9% in 2022. Connecticut, Rhode Island, New Jersey, Maryland and New York had the highest SNF FFS utilization rates, while Alaska, Oregon, South Carolina, Montana and Nevada had the lowest SNF FFS utilization rates.

Of note, year-over-year change in admissions increased only in Alaska and Hawaii in 2023 – all other states experienced a decrease in nursing home admissions. Texas saw the greatest decrease in nursing home admissions for 2023 at a 22.8% drop.

Trella researchers said it’s possible that the industry still needs some time to recover from the pandemic, or that a slightly lower SNF FFS utilization is the new normal.

Looking at MA penetration for the care continuum, Trella saw that MA increases eclipsed the 50% mark in 2023, hitting 54.7% as of February 2024. Meanwhile, FFS inpatient discharge rates for nursing homes inch closer to pre pandemic levels.

Skilled nursing admissions decreased by 12.2% in 2020, Trella found, and it’s likely that 2022 will show an even greater increase than 2021’s 21.1% bump. This is because, relative to 2019, MA skilled nursing admissions haven’t increased at the same rate as MA enrollment.

Other experts, including Divesh Aldasani, vice president of strategy and operations for Bayada Home Health Care, are saying that the rising prevalence of MA, with its tendency to underpay providers, is directly undermining leaders’ ability to adequately staff and deliver sustainable care.

Aldasani’s sentiments, echoed in nursing homes, was part of what Trella calls its “Voices of Experience” within the report.