Post-acute care patient volume continues to rebound, with home health agencies recovering much more rapidly than skilled nursing facilities (SNFs).
That general statement has been true for the past few months. But now, new data suggests the volume shift is likely part of a long-lasting trend, according to Tom Martin, director of post-acute care analytics at CarePort, a WellSky company.
“I think we might be beginning to see what that new normal is going to look like,” Martin told Home Health Care News.
Over the past year, hospital in-patient volume has steadily inched its way upward after levels hit a pandemic-low in April 2020. In fact, at the end of this March, hospital in-patient volume reached 98% of pre-pandemic baselines, with volume not dipping below 90% of historic norms since early January.
That CarePort data comes from 44 hospitals in 13 states.
“We are very close to getting back to 100%,” Martin said. “I will also add … that we’ve seen referrals going into the post-acute space almost reach 100% as well. So whatever this new normal is, the volume is looking close to what it was in 2019.”
While total post-acute care volume is nearing pre-pandemic levels, it varies greatly between settings.
Home health patient volume, for example, dropped all the way to just 69% of baseline levels in April 2020, but then quickly recovered in May and June, reaching 89% and 105% of its pre-pandemic mark, respectively. SNF patient volume similarly plummeted to just 70% of baseline levels last April, yet it only gradually improved over the following six or seven months.
CarePort’s most recent figures show home health volume hit 116% of pre-pandemic baselines at the end of March 2021. Meanwhile, SNF volume climbed to just 91% of the 2019 mark.
CarePort’s post-acute care numbers come from an analysis of 398 hospitals in more than three dozen states.
“With referrals in March of 2019 amongst our almost 400 hospitals, we were seeing roughly a 50/50 split. Patients going to a post-acute setting, about half of the time they were being referred to SNF, half the time they were being referred to home health,” Martin said. “In March of 2021, we saw the same volume of referrals to the post-acute space. But instead of that 50/50 split, we saw a 60/40 split in favor of home health.”
In other words, total post-acute care volume in 2021 looks very similar to 2019 at first glance, but now skews more toward the home health setting.
That could be due to a variety of reasons, such as home health providers proving their mettle throughout the public health emergency, leading to more confidence from potential referral partners with “jump-ball patients.”
The Elixhauser Comorbidity Index — a method of categorizing comorbidities of patients based on the International Classification of Diseases (ICD) diagnosis — backs that up, Martin explained.
The Elixhauser Comorbidity Index for home health patients in 2021 is about half a point higher than in 2019, meaning individuals going to home health are generally sicker and more complex than in the past.
“What we’re seeing is that, in 2021, the average acuity index of the patient in home health is about a half a point higher, so like a 10.5 in 2021 as opposed to a 10 in 2019,” Martin said. “That is sort of telling me that a lot of these patients, the sicker patients that were going to skilled nursing, acute providers are now sort of more willing to send some of those patients home.”
Another interesting takeaway from CarePort’s data: the percentage of patients being referred into post-acute care with a diagnosis code related to a possible COVID-19 recovery.
At the height of the pandemic, upwards of 40% of patients discharged to post-acute care were going to the SNF or home health settings to recover from the coronavirus. At the end of March 2021, that dropped to just 5% of patients.
“The amount of COVID patients we’re seeing has strongly diminished,” Martin said.
It’s important to note that many of these figures are averages.
While some hospitals have seen the patient volume mostly recover, others have not, Martin noted. The same can be said for home health and SNF providers.