FFS Home Health Admissions Continue To Fall As Utilization Eclipses Pre-Pandemic Levels

Fee-for-service (FFS) home health admissions are decreasing quicker than FFS enrollment. Meanwhile, Medicare Advantage (MA) admissions are on the rise.

That’s according to the 2023 post-acute care industry trends report from Atlanta-based analytics and metrics firm Trella Health.

The report takes a closer look at a number of topics, including MA enrollment, home health admissions and other utilization data.


Between Q2 of 2019 and 2022, annual FFS admissions fell by 16.4%, on average. In that same time frame, fee-for-service enrollment fell by 9.1%.

One of the reasons for such a substantial drop in admissions is due to the drop in FFS inpatient discharges, Trella Health’s senior data analyst Carter Bakkum said Wednesday during a webinar.

Between Q3 of 2019 and Q3 of 2020 — which included nearly half a year of the COVID-19 pandemic — discharges dropped by 13.7%. In the next two years, discharges fell by 7.3% in 2021 and 5.8% in 2022.


On a national average, FFS home health admissions fell by nearly 9% from the third quarter of 2022 to 2023.

Despite some of the low admission rates, home health utilization rates have not only reached, but exceeded, pre-pandemic levels – a sign that the demand for home health services is strong.

Pre-pandemic, home health utilization in the third quarter of 2019 was 28.1%. After more than two years of decline, that number is now 29.1%.

Home health utilization refers to the number of patients discharged from an in-patient stay and admitted to home health.

“Utilization and adherence rates higher than pre-pandemic levels indicate the drop in FFS home health admissions is a better explanation for the overall decrease in national home health admissions than changes in these metrics,” the organization wrote in the report.

While the national average figures are helpful for benchmark reasons, Bakkum said agencies should use Trella Health’s data and compare it to their state and local figures as much as possible.

“This is another good gauge to keep in mind, especially when you’re thinking about your service area, the market that you operate in,” he said. “How is the fee for service performing in your area, how does that compare to the national trend declining? What’s the impact of those enrollment numbers on home health admissions in your area? It’s two sides of the same coin.”

The same method applies to utilization. In its report, Trella Health points out that low home health utilization in a state like Montana — 15.4% lower than the national average in Q3 2022 — may indicate unmet demand for home health agencies or a lack of perceived value.

“While a less densely populated area like Montana may be more difficult to service logistically, the impact of increasing utilization may drive significant referral volume,” the organization reported.

Trella Health reported – like many others – that national MA enrollment grew to 29.6 million in 2022, and that it may soon eclipse 50% of Medicare-eligible beneficiaries. Meanwhile, national FFS enrollment decreased by 1.3 million (3.4%) between 2021 and 2022.

Data from other sources suggest MA enrollment did surpass the important 50% mark in 2023.

“Medicare Advantage enrollment is not only increasing, but it’s potentially increasing at a faster rate than we’ve seen historically, especially pre-pandemic,” Bakkum said. “What that means for post-acute care agencies is they have to be aware of not only the national trends, but also the specific, local trends.”

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