Alzheimer’s and related dementia (ADRD) episode payments and 30‐day readmission rate and timing comparing skilled nursing facility and home health discharge destinations in a statewide collaborative

Background ADRD patients are high resource utilizers for hospitals and health systems with higher levels of hospitalization than their non‐ADRD counterparts. Quantifying the cost and readmissions based on where patients are discharged can provide additional information on the resource expenditure for this patient population. This study examined medical and surgical hospitalizations in a statewide collaborative to estimate total 30‐day episode payments and all‐cause readmissions for ADRD patients in a matched cohort of those discharged to skilled nursing facilities (SNF) versus home health (HH). Method We performed a retrospective cross‐sectional analysis of adults with ADRD using the Michigan Value Collaborative (MVC), which is a Blue Cross Blue Shield funded clinical quality initiative. This dataset uses administrative claims representing Medicare and private insurance using 30 and 90‐day episode based price standardized payments. The study period covered 2012 to 2017.We conducted bivariate analyses of baseline demographic characteristics and comorbid conditions for medical and surgical episodes among ADRD patients with SNF versus HH post‐discharge payments. Controlling for selection bias, we performed propensity score matching for ADRD patients with SNF versus HH 1:1 at a caliper of 0.001 without replacement adjusting for age, sex, 79 hierarchical condition categories (HCC), 27 different medical/surgical hospitalization types, and insurance status (Blue Cross Blue Shield or Medicare). Post‐matched differences on risk adjusted, winsorized, price standardized 30‐day medical/surgical episode payments and all‐cause readmissions were compared. Result After propensity matching, there were 6,024 SNF and HH ADRD matched pairs. Total 30‐day episode payments were significantly higher for SNF users ($41,719; 95% CI: $41,325, $42,112) compared to their HH counterparts ($24,132; 95% CI: $23,806, $24,458) with a difference of $17,587 (95% CI Diff: $17,075, $18,098). Furthermore, ADRD patients with SNF utilization had higher readmissions (29.1%; 95% CI: 27.9%, 30.2%) than those discharged for HH (21.4%; 95% CI: 20.4%, 22.4%; Rate Diff 7.7%; 95% CI Rate Diff: 6.2%, 9.3%). Substantially higher total post‐discharge episode payments were seen for SNF utilizers (Diff: $18,126; 95% CI Diff: $17,720, $18,531). Conclusion Our study demonstrates total 30‐day episode payments, readmissions, and post‐discharge payments are substantially higher for SNF ADRD patients compared to HH in a matched cohort.