Hospital Discharges to Home Health Bounce Back, SNF Volumes Remain Down

At the height of the COVID-19 emergency, in-patient hospital volumes fell, with skilled nursing facilities (SNFs) and home health providers experiencing similar downturns. While home health providers began to see a turnaround in June, the same can’t be said for SNFs.

That’s according to a recent Avalere Health study examining discharge destinations recorded on in-patient hospital claims for Medicare fee-for-service beneficiaries.

Washington, D.C.-based Avalere is a health care consulting firm that specializes in strategy, policy and data analysis for life sciences companies, health plans and providers.


Specifically, Avalere researchers found that discharges to home health saw a year-over-year increase in June, with a 4.6% increase in discharge volume. Meanwhile, SNFs saw a 25.4% decrease in year-over-year discharges, which was below pre-pandemic levels.

By July, there was a 34% decrease in patients discharged from hospitals and into SNFs. Home health volumes took less of a hit, with only a 1.8% decrease.

“The main takeaway, from my perspective, is we’re seeing that the hospital discharges to SNFs are not rebounding in the same way as hospital discharges to home health,” Heather Flynn, a consultant at Avalere Health, told Home Health Care News. “We’re seeing that this could indicate some increasing use in home health relative to SNFs.”

Source: Avalere Health

Throughout the public health emergency, many have tried to avoid institutional settings. Facilities with a large number of residents or patients can often become sites of possible COVID-19 outbreaks.

“The hypothesis that we are working from, due to COVID, there may be caution in the use of in-patient settings, in general,” Flynn said. “When faced with the choice of in-patient versus community care, given the pandemic, use of care at home may be a preference for some beneficiary.”

As the COVID-19 emergency continues, some experts have asserted that the U.S. health care system will become increasingly decentralized, with more services pushed further into the home.

During the early days of the public health emergency, there were greater restrictions around visiting SNFs.

Additionally, some home health leaders believe that there will be stricter regulations and capacity caps for SNFs moving forward, in turn widening the pool of patients that can be shifted into the home.

“I think in the next five years, the SNF industry is going to undergo a significant transformation,” Bruce Greenstein, chief strategy and innovation officer at LHC Group, said earlier this month at the 2020 Baird Global Healthcare Conference. “The facilities themselves are designed very well for efficiency but not infection control. You can see policies that will roll out over the next two years that will help the SNF industry, but reduce their capacity.”

Some home health providers have already started to enter the SNF-at-home market, retooling their operations to handle more acute patients otherwise served in a SNF.

While the findings from Avalere Health seemingly bode well for home health providers looking to take on more acute patients or officially enter the SNF-at-home space, it may be premature to use this data as a measure of future opportunities, according to Flynn.

“I don’t know that we’re jumping there yet,” she said. “I think, right now, the trends that we are seeing are the COVID-related impacts.”

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