Retrospective Analysis of Outcomes in Qualified and Non-Qualified Medicare Admissions in a Long-Term Acute Care Hospital During Year One of the Pandemic Waiver Period (preprint)

ABSTRACT

Objective: To compare the characteristics and outcomes of Medicare insured patients admitted to the long-term acute care hospital (LTCH) setting, before and during the first year of the CARES Act, and to determine whether there is functional benefit or projected cost-savings associated with admitting non-qualified patients beyond the waiver period. Data Source and Study Setting: Using the LTRAX outcome and demographic reporting system, primary data was collected for all Medicare insured patients admitted March 2019 through February 2021. Study activities were conducted at an independent LTCH located in Connecticut, USA. Study Design: This was a single-site retrospective cohort study. For each cohort, demographics and CMS required assistance scores for metrics such as self-care, communication, and functional mobility were compared. A sub-analysis of the stroke population was also conducted. Data Collection/Extraction Methods: Collected data were separated by admission date [historic control cohort (March 2019 through February 2020) or COVID-19 cohort (March 2020 through February 2021)] and qualified status. Principle Findings: Analysis revealed that non-qualified and qualified Medicare patients admitted before and during the COVID-19 waiver period were characteristically similar, were functionally similar at admission, and received a similar significant rehabilitation benefit. The stroke sub-analysis again demonstrated functional similarities between cohorts. However, in this sub-population, the traditionally non-qualified population saw a significant increase in the proportion of patients discharged home and a significant reduction in acute care readmissions within 30-days post LTCH discharge. Conclusions: Despite not meeting the three-midnight qualification, the non-qualified population was functionally similar at admission and received a similar rehabilitation benefit as the qualified population, while discharging home more often. This data then makes a compelling case to eliminate the three-midnight stay qualifier for LTCH admission, which would ultimately improve the rehabilitation outcomes and decrease the lifetime cost of care and caregiver burden for the traditionally non-qualified Medicare population.