Post-Acute Care in Inpatient Rehabilitation Facilities Between Traditional Medicare and Medicare Advantage Plans Before and During the COVID-19 Pandemic.
Ying Jessica Cao, Dian Luo
PMID 37148906WHAT IT FOUND
During the pandemic, inpatient rehabilitation stays became shorter and more expensive, with far more patients discharged home with home health care and fewer to nursing facilities.
Differences between traditional and managed care plans narrowed, but the study shows association, not cause.
Key findings
01After adjusting for patient and facility characteristics, length of stay was significantly shorter during the pandemic for stroke and cardiac admissions, while payment per episode increased for all conditions in the first three months.
02Discharges to home with home health care increased significantly, while discharges to skilled nursing facilities and home without care decreased, particularly for stroke and fracture patients.
03Functional improvements in self-care and mobility did not significantly change during the pandemic compared to the pre-pandemic period, except for stroke and fracture conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is observational and cannot prove that the pandemic caused these changes; it only shows associations. The data did not include information on whether patients had active COVID-19 infections, which could have influenced length of stay and outcomes, particularly for pulmonary conditions. Community-level COVID-19 severity varied by region, but the analysis used national averages, which may mask important local differences. The study excluded patients who died during their stay, had stays shorter than 3 days or longer than 30 days, or were transferred from other facilities, so it does not reflect the most severe or complex cases.
Declared interests
The authors reported no conflicts of interest. The study was supported by grants from the National Institute on Aging and the National Institute of Nursing Research.
The easy way to misread this
Do not interpret the shorter length of stay as a sign of improved efficiency or better care. The study shows that patients were sicker on average during the pandemic, yet stays were shorter and costs were higher, which may reflect resource constraints or discharge pressure rather than clinical improvement. Additionally, the lack of data on individual COVID-19 status means we cannot know how the virus itself affected recovery trajectories.