SNFs Retook Higher Hospital Discharge Share Than HHAs In Early 2022

After the public health emergency was declared in March of 2020, hospital discharges bottomed out the following month. While they ticked back up in 2021 and 2022, they still remain 25% lower than they were in February of 2020.

And while home health care gained a greater share of post-acute referrals compared to skilled nursing facilities (SNFs) early on in the pandemic, there’s been normalization since then.

This is according to a new data analysis conducted by the Washington, D.C.-based advisory and research firm ATI Advisory. The analysis took into account Medicare fee-for-service patients from January 2019 to February 2022, and paid through March 2022.


Specifically, from November 2021 to February 2022, SNFs consistently received a higher share of discharges than home health care agencies. Those months looked more similar to pre-pandemic months.

Source: ATI Advisory

In fact, while SNF discharges dropped by 2% year over year from 2020 to 2021, they ticked up by 1.2% from February 2021 to 2022, the largest gain of any post-acute setting. Meanwhile, home health agencies’ share of discharges dropped by 1.7% from February 2021 to February 2022.

Source: ATI Advisory

Overall, from March 2020 to February 2022, home health agencies scored 18% of hospital discharges. For COVID-19 patients, that number fell to 14%. Meanwhile, SNF share was at 16% and 18%, respectively.


SNF discharge normalization was expected by most in the post-acute space, even during the height of COVID-19. After all, some patients’ acuity levels are too high to be cared for in the home.

More SNF-at-home and even hospital-at-home programs could change that, but in all likelihood, that would be much further down the line.

Plus, despite the Medicare fee-for-service data displayed, there are still signs to suggest that home health referrals are much higher overall than they were prior to the pandemic.

Even if demand for home health services is increasing, that demand coming to fruition for agencies’ bottom lines is all based on staffing capacity. In January 2022, the industry’s referral rejection rate had reached 58%, according to WellSky.

“This is telling us that [providers] can’t take this high volume of patients looking for home health services, and they’re starting to turn down more and more patients from their referral partners,” Tom Martin, director of post-acute care analytics at WellSky, told Home Health Care News at the time.

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