Medicare fee-for-service (FFS) admissions increased among skilled nursing facilities by 5.8% and decreased among home health providers year-over-year in the third quarter of 2022, according to a report released Monday from Trella Health.

Data from the Atlanta-based healthcare analytics company’s annual post-acute care industry trend report also show that FFS admissions remained stable for hospice providers, with a 0.1% decrease.

Overall, national FFS enrollment continues its downward trend, decreasing by 1.3 million people (3.4%) between 2021 and 2022. As FFS declines, national Medicare Advantage enrollment is growing, according to the report. National MA enrollment grew to 29.6 million in 2022. Almost half of Medicare-eligible beneficiaries (46.2%) as of late 2022 are enrolled in MA plans. Trella anticipates that number to exceed 50% as soon as 2024.

MA enrollment grew at a faster pace than the Medicare-eligible population, increasing 10% between 2021 and 2022 compared with a 2.3% increase in the Medicare-eligible population. MA enrollees, according to the report, likely were “enticed by factors such as added benefits and lower out-of-pocket costs.”

As McKnight’s previously reported, a growing number of MA plans serving nursing home residents are picking up the cost of added services, such as resident companionship, music therapy and transportation. Under updated regulations, those services can be covered because they help address isolation and other psychosocial needs.

Discharge rates

Year-over-year FFS inpatient discharge instructional rates for skilled nursing and home health moved toward pre-pandemic levels. “However, it remains to be seen whether they will stabilize or find a new normal post-pandemic,” the authors wrote.

Post-acute care discharge instructions increased from 52.3% to 52.7% between the third quarter 2021 and third quarter 2022 reporting periods.

“The increase in inpatient discharge instructional rates to post-acute care is driven by many factors, including a reduction in COVID-19-related hospitalizations and higher average acuity [higher needs] of inpatient discharges,” according to the report.

Staffing challenges eased somewhat in 2022 from the height of the pandemic, “further explaining why 2022 skilled nursing admissions increased year-over-year,” according to the report.