The quality of care and spending among skilled nursing facilities (SNFs) across the U.S. varies widely, particularly for dual-eligible residents – those who qualify for both Medicaid and Medicare – according to federal data released on Wednesday.

In its National Summary Report, the Centers for Medicare & Medicaid Services (CMS) shared metrics related to discharge and Medicare spending, providing insights into how various factors impact patient outcomes. The report gathers together the findings from the 2023 Health Equity Confidential Feedback Reports, the agency said. 

The latest report shows clear disparities in care outcomes based on patients’ dual-enrollment status and race and ethnicity, revealing that dual-enrolled patients and Non-White patients often experience worse outcomes compared to their non-dual and White counterparts.

Moreover, the national average rates for successful discharges to the community (DTC) and Medicare spending per beneficiary (MSPB) were notably poorer for dual-enrolled and Non-White patients across most post-acute care settings. And, over half of the facilities in each care setting had worse DTC and MSPB outcomes for dual-enrolled patients compared to their non-dual counterparts.

Meanwhile, in SNFs, these disparities were more pronounced, with outcomes progressively worsening as the proportion of dual-enrolled and Non-White patients increased.

These CMS reports are aimed at allowing providers to identify the gaps in care and implement improvements that not only address disparities but also drive better health outcomes across diverse patient populations.

Discharge rates

The DTC measure, which reflects the rate at which patients are successfully discharged to the community, showed significant disparities. Lower rates suggest worse performance on the DTC measure.

At the median SNF, the DTC rate for dual-enrolled and Non-White patients was worse than the national average for all patients. Over 37% of SNFs reported significantly worse discharge rates for their dual-enrolled patients compared to the national average.

Moreover, at individual SNFs, dual-enrolled patients had worse DTC rates compared to non-dual patients. About 24% of SNFs had DTC rates that were significantly worse for dual-enrolled patients compared to non-dual patients. However, the DTC rates for Non-White patients were similar to or better than those for White patients within the same facilities.

All in all, facilities with a higher proportion of dual-enrolled patients or Non-White patients generally showed a progressive reduction in DTC rates, meaning these residents stayed longer. This trend was also consistent across the long-term care sector.

Insights into Medicare spending

The MSPB measure, which tracks Medicare spending during and shortly after a patient’s treatment period, also highlighted wide disparities. Higher Medicare spending amounts indicate worse performance on the MSPB measure.

In most post-acute care settings except SNFs, the average Medicare spending amount for dual-enrolled and Non-White patients was better than the national average. However, in SNFs, dual-enrolled and Non-White patients faced worse average Medicare spending amounts compared to the national average. Over 25% of SNFs reported worse average MSPB amounts for dual-enrolled and Non-White patients.

The median facility in all settings showed worse Medicare spending for dual-enrolled patients compared to non-dual patients, but similar or improved Medicare spending for Non-White patients compared to White patients. However, a majority of facilities – about 85% to 94% – did not show statistically significant differences in MSPB amounts between dual and non-dual patients or between Non-White and White patients.

Overall, facilities with a higher proportion of dual-enrolled patients or Non-White patients experienced a progressive increase in Medicare spending amounts. This trend was evident among long-term care hospitals (LTCHs) and SNFs, reflecting higher costs associated with these patient groups.