Hospital Discharges to Post-Acute Care Indicate Changing Preference for At-Home Services

By Carter Bakkum | May 2, 2022

Inpatient Discharge Instructions by Destination, 2020 Q4 – 2021 Q3*

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*Inpatient discharge data is source from 100% of Medicare Part A and Part B claims data

Rebounding post-acute care instructions after inpatient discharge


Post-acute instructions to home health and hospice increased considerably between the 2019 Q3 – 2020 Q2 and 2020 Q4 – 2021 Q3 reporting periods. Pandemic-induced fears of post-acute care providers’ ability to provide safe care and new regulations surrounding equipment and personnel hurt PAC instructions in 2020, leading to an increase in the percentage of patients who received no PAC instructions to 48.9% for the 2019 Q3 – 2020 Q2 reporting period. As personal protective equipment became more available between 2020 Q4 and 2021 Q3, as well as agency adjustments to referral strategies, PAC instructions rebounded to pre-pandemic levels from 51.1% to 52.2%.



Discharge instruction destinations changed significantly

There were initial concerns with skilled nursing facilities’ ability to manage COVID-19 patients since they could be a hotspot for transmission of the virus and were prioritized below hospitals for the limited supply of personal protective equipment. Further, stay-at-home orders emphasized the attractiveness of home health rather than skilled nursing care, contributing to a 2.5 percentage point increase in the number of home health and a 2.4 percentage point decrease in skilled nursing discharge instructions from the 2019 Q3 – 2020 Q2 reporting period. Hospice discharge instructions grew by 0.6 percentage points, indicating an increase in physicians’ and facilities’ recognition of the importance of end-of-life care. 


Further investigations into post-acute care trends

This blog leveraged much of its information from Trella’s Industry Trend Report. For more insights on trends in the post-acute industry and how you can use data to drive strategic decision-making, download the full Industry Trend Report here. For more analyses into Medicare data and how data illustrates the importance of post-acute care and how to take advantage of changing healthcare, all my analyses are saved on my author page, linked here.


About the Author:

Carter Bakkum, Senior Data Analyst, Healthcare Insights

Carter is a senior data analyst who works to turn complex, messy data into actionable intelligence. Carter studied economics and statistics at the University of Virginia before joining an economic consulting firm, where he supported expert testifying economic witnesses on behalf of fortune 500 healthcare companies. After the significant changes in the importance of data analytics during the pandemic, Carter joined the Trella team to dive deeper into the numbers to uncover the stories that drive our experience.