Telehealth policies have loosened since the pandemic began, helping feed the surge in at-home recoveries. Medicare has relaxed guidelines for the kinds of patients eligible for services that make rehab at home possible, and many insurance plans now cover those services.
“A lot of people don’t realize, when you check into a hospital, you really need to check out what the discharge plan will be,” says Elaine Ryan, vice president for state advocacy and strategy at AARP. “When you’re discharged, the question is: Can you receive in-home rehabilitation? And the answer is yes. You don’t have to go into those centers.”
Avoiding the nursing home
Nursing homes “were fighting a PR battle” even before the coronavirus swept the U.S. and sickened more than 238,000 residents, says Fred Bentley, managing director of Avalere Health. The pandemic has made that PR problem “way, way worse.”
“We are going to find patients who before COVID would have gone into a facility, no questions asked, and now they have options,” Bentley says.
That’s a problem for nursing homes, which for decades have depended on Medicare payments from short-term rehab patients. Many homes rely on Medicaid payments from long-term care residents but on Medicare reimbursements from short-term patients who’ve been discharged from the hospital after a fall, illness or elective procedure.
“Because Medicaid rates are quite low, [nursing homes] depend heavily on patients insured by Medicare, and Medicare pays for post-hospital care in nursing homes,” says the University of Pennsylvania’s Werner. Nursing homes averaged $544 per patient day in Medicare revenue from rehab patients last year, according to data from the National Investment Center for Seniors Housing & Care. That’s more than twice Medicaid’s rate of $216 per patient day from long-term care recipients.
But nursing homes’ Medicare revenue cratered when hospitals across the country