While home health admissions dipped in 2022, hospice admissions remained steady. Meanwhile, Medicare Advantage enrollment continues to climb, a report released Monday from market intelligence firm Trella Health found.
National year-over-year fee-for-service home health admissions decreased by 8.6% in the second quarter of 2022, to 772,100 from 845,200 in the year-earlier quarter. Compared to the second quarter of 2019, FFS home health admissions in the second quarter of 2022 dropped by 16.4%.
Home health admissions fell more rapidly than FFS enrollment. The decrease of 16.4% was more than 7.3 percentage points higher than the 9.1% decrease in FFS enrollment over that period, Trella Health’s Annual Post-Acute Care Industry Trend Report found. One reason home health admissions decrease faster than FFS enrollment could be the substantial decline in FFS patient discharges, the report said.
It also appears that more people are entering skilled nursing facilities and fewer receiving home health after hospital visits — indicating a return to pre-pandemic rates. Between the third quarter of 2021 and third quarter of 2022 reporting periods, the percentage of inpatient discharges instructed to seek SNF care increased by 1.4 percentage points. However, home health instructional rates decreased by 1.2 percentage points.
Hospice admissions
Compared to home health, hospice admissions stayed even last year. Trella Health’s report found that year-over-year FFS hospice admissions in the third quarter of 2022 slipped by a scant 0.1% from the third quarter of 2021. But admissions increased by 2.7% and 0.6% in the first two 2022 quarters, respectively. The consistency of admissions in the third quarter of 2022 “may be surprising given the continuous discussion of an aging population,” the report said.
Effects of COVID-19 affected hospice admissions in 2021 and 2022. “Waves of mortalities shown in 2020 Q4, 2021 Q1, 2021 Q4, and 2022 Q1 coincide with high rates of COVID-19 infection, skewing quarterly year-over-year metrics to show temporary shifts that may not directly align with longer-term trends,” the report said.
MA enrollment rises
Medicare Advantage enrollment continues to rise. In 2022, MA enrollment grew 10% to 29.6 million, or 46.2% of Medicare-eligible beneficiaries. The report found that percentage could pass 50% as soon as 2024. The Medicare-eligible population grew 2.3% to 64.1 million in 2022. A recent report from the Kaiser Family Foundation found that MA exceeded 50% of all Medicare lives in January.
FFS enrollment decreased 3.4% between 2021 and 2022.
“Many beneficiaries covered by FFS in 2021, likely enticed by factors such as added benefits and lower out-of-pocket costs, switched to an MA plan in 2022,” the report said.
National MA home home health admissions aligned with enrollment trends. Between 2019 and 2020, national MA enrollment increased by 9.5% to 24.5 million from 22.3 million. One reason for the alignment between the increase in MA home health admission rates and admissions could be geography, the report said.
“MA enrollment tends to be much higher in more densely populated and metropolitan counties, where providing home health services is logistically easier, the report said.
