Industry Trend Report 20

Industry Trend Report

2020

A Note from Ian Juliano, CEO 3

Medicare Beneficiaries 5

Post-Acute Care Discharge Instructions and Adherence 6

Home Health 9

Hospice 13

Skilled Nursing 17

COVID-19 20

About Trella Health 28

Appendix 29

TABLE OF CONTENTS

Click the section title above to navigate to the corresponding section.

3© 2021 Trella Health. All rights reserved.

In addition to our usual breakdown of the changes and trends we’ve seen in the industry, this year’s report will also explore initial insights into the impact of COVID-19. For many metrics, we compared Q1 and Q2 2019 to Q1 and Q2 2020. Some of the key takeaways are:

• The balance of Fee-for-Service (FFS) and Medicare Advantage continues to shift: ➥ MA penetration continued to grow, eclipsing 40% of all Medicare beneficiaries in Q4 2020. ➥ While Medicare FFS enrollment increased in 2019 – from 37.6M in Q1 to 38.2M in Q4 – FFS enrollment decreased slightly in 2020 – from 37.1M in Q1 to 36.9M in Q4.

• Home health admissions have sharply declined since 2018 while adherence rates continued to impact patient outcomes:

➥ Home health admissions decreased 5.2% year-over-year in Q1 2020. This could be due to a decline in overall FFS beneficiaries, a lower rate of home health referrals, and a reduced number of elective surgeries at the beginning of the pandemic.

➥ Patients who did not adhere to home health instructions following an inpatient stay were 26% more likely to be readmitted within 30 days than those who adhered.

A NOTE FROM IAN JULIANO, CEO

In the past few months, I have been absolutely amazed by the entire healthcare industry’s resilience and strength. Many in our industry have faced unheard of obstacles and setbacks, but those challenges led to a new wave of innovation, allowing many of you to create a new path to normalcy.

And it’s that spirit of innovation and support of this fantastic industry that has inspired

our team to make the improvements and enhancements we have made over the past year. From launching Mosaic, our new network management solution for Accountable Care Organizations (ACO) and Direct Contracting Entities (DCE), to gaining access to Medicare Advantage (MA) data, we’ve worked hard to increase the transparency and visibility into your markets’ trends.

The state of post-acute care – and healthcare in general – is likely to be changed forever in the wake of COVID-19. While the full depth of the pandemic’s impact is still unknown, we will continue reporting as new data becomes available.

Ian Juliano | CEO, Trella Health

“”


• Skilled nursing facilities experienced the most significant impact from COVID-19: ➥ The effect of the pandemic on skilled nursing admissions is well documented, with a national year-over-year admission decline of 21.4%.

➥ Despite the reduced admissions, Medicare Average Length of Stay (ALOS) for SNF patients increased 10.5% quarter-over-quarter to 26.3 days in Q2 2020.

• However, other care settings were also impacted: ➥ At 48.9%, nearly half of all inpatient stays for the Q2 2020 reporting period did not include post-acute care (PAC) instructions upon discharge. This represents a slight increase from the 47.8% of episodes that were not referred to PAC during the Q1 2019 reporting period.

➥ COVID-19 had the third-highest two-year inpatient mortality rate, at 9.8%, exceeded only by neoplasms and sepsis.

• Increased concern and awareness of COVID-19 led to new regulations and waves of innovation in the healthcare community:

➥ The Centers for Medicare & Medicaid Services (CMS) eased regulations for practicing telehealth, partially mitigating a large gap in healthcare delivery, as in-person physician visits were significantly restricted.

➥ Telehealth claims rose, as was anticipated, but far outpaced expectations by skyrocketing 3334% year-over-year in April.

The state of post-acute care – and healthcare in general – is likely to be changed forever in the wake of COVID-19. While the full depth of the pandemic’s impact is still unknown, we will continue reporting as new data becomes available. What lasting consequences can we anticipate? Will the rise in telehealth continue as a method to securely – and safely – treat patients in the comfort of their own homes? Will we see an increase in post-acute discharge instructions for home health and a subsequent rebound in admissions, given the increased awareness of the care setting in the second half of 2020? And how will this impact the traditional FFS model? Hospitals, in particular, were decimated financially by the loss of many elective FFS procedures, while capitated MA plans were far better positioned to weather the pandemic. Will COVID-19 hasten the migration to value-based care?

These are just a few of the questions we’re committed to investigating now and in the future. As always, we strive to deliver the most impactful and accurate insights to our customers so that you may, in turn, improve the state of healthcare in our nation. I look forward to hearing your feedback on this report and would love to know how we can iterate on it in the future to deliver even more value.

“Thank you for everything you do – and thank you for partnering with Trella to impact even more meaningful change in healthcare.“

Sincerely,

CEO, Trella [email protected]

mailto:ian%40trellahealth.com?subject=


The total number of Medicare beneficiaries grew by approximately 1.5 million from Q2 2019 to Q2 2020, representing 2.5% growth. During that period, the number of MA enrollees increased 9.4%, from 22.3 million to 24.4 million. Conversely, the number of FFS enrollees decreased 1.9%, by 700,000.

While overall MA penetration continues to grow, access to MA plans varies significantly by geography and favors states with highly populated metropolitan areas. Markets with lower population densities such as Alaska and Wyoming have the lowest MA penetration rates, at 1.6% and 4.6%, respectively. Florida had the highest MA penetration at 49.1%. Nationwide MA penetration reached an all-time high in November 2020, eclipsing 40%.

The gap between FFS and MA enrollment has continued to narrow for the past decade, with beneficiaries consistently electing MA coverage more frequently than traditional Medicare. 2020 was no exception, as FFS enrollment declined or remained stagnant for all four quarters while the number of MA beneficiaries rose by 200,000 each quarter.

MEDICARE BENEFICIARIES1

MEDICARE BENEFICIARIES YEAR-OVER-YEAR

MEDICARE ADVANTAGE PENETRATION BY MARKET AS A PERCENTAGE OF TOTAL MEDICARE BENEFICIARIES

MEDICARE BENEFICIARIES QUARTERLY TREND

22.3M 24.4M

37.7M 37.0M

22.1M 22.3M 22.5M 22.7M 24.2M 24.4M 24.6M 24.8M

37.6M 37.7M 37.7M 38.2M 37.1M 37.0M 37.0M 36.9M

2019 2020

1 Source: Medicare Enrollment Dashboard, Medicare and MA enrollees through Q4 2020.

Medicare Advantage increased 2.1M year-over-year.

➥

Medicare FFS decreased 0.7M year-over-year.

➥


Nearly half (48.9%) of all inpatient stays were not coded with post-acute care instructions upon discharge, representing a slight increase from the Q1 2019 reporting period of 47.8%. Incidentally, 48.9% was also the percentage of inpatient stays discharged without PAC instructions for the Q1 2018 reporting period.

For patients who did receive post-acute care instructions, home health was the most common referral destination. The percentage of stays referred to home health decreased from 23.3% during the Q1 2019 reporting period to 21.6% for the current reporting period.

SNF was the second most likely referral destination, slightly below home health, at 21.0%. Hospice instructions increased from 3.1% in the Q1 2019 reporting period to 3.6% in the Q2 2020 reporting period. Discharges coded for inpatient rehab facilities and long-term care hospitals remained stable, at 4% and 1%, respectively.

POST-ACUTE-CARE DISCHARGE INSTRUCTIONS AND ADHERENCE2

POST-ACUTE DISCHARGE INSTRUCTIONS FROM HOSPITAL INPATIENT SETTING

Patients in states on the East Coast were more likely to receive post-acute care instructions than patients in other parts of the country. The exception was California, which coded 54.7% of inpatient stays for post-acute care.

PERCENTAGE OF INPATIENT DISCHARGES WITHOUT PAC INSTRUCTIONS

2 Source: Trella Health, Medicare FFS patients through Q2 2020


The range of inpatient stays without post-acute care discharge instructions varied significantly and appears to be strongly correlated with geographic location. While two-thirds of episodes in Connecticut were coded with post-acute care instructions, less than one-fourth were in Alaska. Twenty-nine states had post-acute instruction rates between 45% and 55%.

PAC DISCHARGE INSTRUCTIONS AND ADHERENCE

A DISTRIBUTION OF INPATIENT DISCHARGES WITHOUT PAC INSTRUCTIONS


PAC DISCHARGE INSTRUCTIONS AND ADHERENCE

While 21.6% of inpatient discharges were referred to home health on a national level, the percentage of discharges coded for the care setting varied from 7.2% in Montana to 32.3% in Massachusetts.

Just more than half of states’ home health instruction rates hovered around the national average, with 28 states reflecting post-discharge instructions for home health between 17.6% and 25.7%.

Geographically, home health instructions following inpatient stays were more common in northeastern states, including Massachusetts, New Hampshire, Connecticut, Delaware, and Vermont. These states were generally more likely to refer patients to post-acute care upon discharge than other parts of the country, as described above.

A DISTRIBUTION OF INPATIENT DISCHARGES WITH HOME HEALTH INSTRUCTIONS


When looking at 2017 and 2018, home health admissions saw a consistent increase of approximately 3% year-over-year. For the current reporting period, however, admissions decreased by 2.2%.

And compared to Q1 2019, Q1 2020 saw an even more considerable decrease in admissions of 5.2%, which could in part be explained by stay-at-home orders implemented in late February or March and a corresponding drop in inpatient stays, as well as the continued decline of FFS beneficiaries.

HOME HEALTH3

HOME HEALTH ADMISSIONS BY QUARTER


NOTE: Due to home health’s episodic nature, there is a slight delay in claims reporting compared to other post-acute care settings. CMS retroactively submits and updates home health claims for each quarter and does not release 100% of home health claims simultaneously as with the rest of the claims data. To promote more complete reporting, Trella waits to present home health information in the Industry Trend Report until a given quarter’s claims have been adjusted. As a result, the current reporting period reflects claims data from Q2 2019 to Q1 2020.

928K 906K 894K 908K


HOME HEALTH

Utilization tends to vary significantly by market.

As is apparent in both visualizations, this reporting period was no exception, ranging from a low of 13.2% in North Dakota to a high of 38.8% in Massachusetts. The median utilization rate across all states was 27.8%, compared to 26.3% in our previous report. In addition to North Dakota, six states (Minnesota, Wyoming, Hawaii, South Dakota, Alaska, and Montana) had utilization rates below 20%. Incidentally, these same seven states had the lowest utilization rates for the previous reporting period. States with high utilization rates remained relatively consistent, with New Hampshire, Connecticut, Rhode Island, Delaware, Florida, Vermont, and Maine all above 34%.

A DISTRIBUTION OF HOME HEALTH UTILIZATIONBY MARKET

Although admissions were down, home health utilization increased from 27.8% for the Q4 2018 reporting period to 29.3% for the current reporting period. Utilization is defined as the number of patients discharged from an inpatient stay and subsequently admitted to home health during the most recent four quarters, divided by all inpatient discharges for the same four quarters.

HOME HEALTH UTILIZATION BY MARKET


HOME HEALTH

National home health adherence was 71.5% for the most recent reporting period.

Note: Trella has changed how we calculate home health adherence since our last trend report. Previously adherence was based on the percentage of patients who received home health instructions following an inpatient stay and started a new home health episode within 30 days of discharge. Our updated adherence metric is calculated as the percentage of home health episodes started or resumed within 30 days of discharge as instructed, divided by the total number of discharges with home health instructions.

Washington, D.C., and Hawaii remained the markets with the lowest adherence rates, at 50.7% and 57.7%, respectively, while New Hampshire held steady as the top-ranked state, with an 80.4% adherence rate. The median adherence rate was 72.5%, slightly higher than the mean.

With nearly 30% of patients coded for home health not receiving services, educating patients and their providers about the value and importance of home health care remains critical.

HOME HEALTH ADHERENCE BY MARKET


HOME HEALTH

Nationally, patients who adhered to home health instructions following an inpatient stay had a 30-day readmission rate of 12.6%, while non-adhering patients had a 15.9% readmission rate. Non-adhering patients consistently have higher readmission rates than their adhering counterparts. For the most recent reporting period, those who did not follow instructions were 26% more likely to be readmitted to the hospital within 30 days of discharge.

30-DAY READMISSION RATESADHERING VS. NON-ADHERING PATIENTS

12.6%15.9%

Though it has a wide range, this histogram illustrates how states’ adherence rates are clustered, with 34 states between 66% and 75%, and 42 states between 66% and 77%. Washington, D.C.’s adherence rate is by far the lowest at 50.7%.

A DISTRIBUTION OF HOME HEALTH ADHERENCEBY MARKET


Hospice admissions were relatively stable between Q2 2019 and Q2 2020, increasing by just 0.3%. Although admissions decreased 6.6% between Q1 2020 and Q2 2020, this decrease is likely a reflection of seasonality, as the first quarter of any given year consistently has the highest admission count.

In addition to looking at admissions trends to understand national hospice volume, another insightful metric is hospice utilization, which explains how often Medicare decedents elect hospice care towards the end of life. Trella calculates hospice utilization as the percentage of patients who - in a given year - were discharged from an inpatient stay, died, and had a hospice claim within six months before death, divided by all patients who were discharged from an inpatient facility and died during the same year.

Since utilization is based on a one-year period, Q2 2020’s hospice utilization rate reflects patients who died between Q3 2019 and Q2 2020.

Hospice utilization was 46.2% for the current reporting period, compared to 46.9% in the Q1 2019 reporting period. Median utilization was 46.5%. As is typically the case, utilization varied significantly based on market. New York had the lowest utilization rate at 23.1%, while Florida championed the highest, at 58.8%.

Alaska and Washington, D.C., rounded out the bottom three markets, at 23.3% and 25.7%, respectively. These three states lagged behind the fourth-lowest utilizer, North Dakota, by a full eight percentage points.

HOSPICE4

HOSPICE ADMISSIONS BY QUARTER

HOSPICE UTILIZATION BY MARKET

352K 344K 356K 378K 353K



HOSPICE

Most states’ utilization rates were between 40% and 50%.

Although Alaska is consistently among the lowest utilizers, their utilization rate increased by more than five percentage points since Trella last reported on the metric. Meanwhile, New York and Washington, D.C., saw hospice utilization fall by four and five percentage points, respectively.

A DISTRIBUTION OF HOSPICE UTILIZATION BY MARKET


HOSPICE

Hospice ALOS was 79.5 days for the current reporting period, up 1.6 days from our last report, a 2.1% increase. Median ALOS was 76.2 days.

With an ALOS of more than 100 days, Utah and Alabama had the highest ALOS of all states, while Wyoming’s was the lowest by far, at 34.8 days. Wyoming’s ALOS was also nearly 15 days less than the second-lowest ALOS (Alaska) of 49.5.

A DISTRIBUTION OF HOSPICE ALOS BY MARKET


This chart shows hospice admissions by diagnostic category for this reporting period. Compared to our last reporting period, significant changes include:

• An increase in neoplasm admissions by 3.0 percentage points.• A decrease in nervous system, circulatory, and endocrine admissions by 1.6, 0.5, 0.9

percentage points, respectively.

The Q2 2020 reporting period saw a newly introduced diagnostic category for COVID-19, which accounted for 0.6% of hospice admits, despite COVID-19 not being reported as a diagnostic category until April 2020.

HOSPICE

HOSPICE ADMISSIONS BY DIAGNOSTIC CATEGORY (Q3 2019 – Q2 2020)


Skilled nursing admissions have been steadily decreasing for the past few years, and COVID-19 caused an even steeper decline. A year-over-year decrease of 21.4% illustrates the stark impact of the pandemic. When analyzing the 50 states and Washington, D.C., 48 states experienced a decline in year-over-year admissions. Only three states witnessed a year-over-year increase in SNF admissions: Louisiana (13.7%), Connecticut (4.5%), and Massachusetts (2.7%).

SNF 30-day readmission rates calculate the percentage of a SNF’s patients admitted to a short-term acute stay within 30 days of initial inpatient discharge. Note: this metric looks back eight quarters. The 30-day readmission rate was 15.0% in this reporting period, compared to 16.2% when we last reported the metric. The median 30-day readmission rate was 14.6%, compared to 15.8% previously.

Alaska, Idaho, and Utah represented the lowest readmission rates of 8.6%, 9.2%, and 9.8%, respectively. In contrast, New Jersey, Michigan, Florida, and Illinois all had readmission rates greater than 16%.

SNF utilization is calculated much like home health utilization, with the number of patients entering skilled nursing following an inpatient stay over the most recent four quarters divided by all inpatient discharges for the same four quarters. SNF utilization was 23.5% for this reporting period, compared to 25.1% for the previous reporting period. Utilization varies significantly from state to state. Connecticut had the highest rate at 30.6%, while Alaska was the lowest at 7.5%. All but five states had a concentrated SNF utilization between 18.2% and 27.1%.

SKILLED NURSING5

SNF ADMISSIONS BY QUARTER

SNF 30-DAY READMISSION RATE BY MARKET

SNF UTILIZATION BY MARKET

540K 518K 511K 514K425K



Medicare SNF ALOS was consistent between Q3 2019 and Q1 2020, ranging from 23.6 to 23.8 days. In Q2 2020, however, ALOS increased 10.5% quarter-over-quarter to 26.3 days. While there were significantly fewer SNF admissions in Q2 2020, patients tended to stay longer. This could, in part, be due to COVID-19 regulations requiring all patients to undergo a mandatory 14-day quarantine. Furthermore, when quarantined, patients were unable to participate in therapies requiring the use of common areas – further prolonging the length of stay.

For the most recent reporting period, New York and Alaska had the highest SNF ALOS, at 28.7 and 28.4 days, respectively.

Iowa and Massachusetts had the lowest SNF ALOS of 18.6 and 19.7 days, respectively.

SKILLED NURSING

SNF MEDICARE ALOS BY QUARTER

SNF MEDICARE ALOS BY MARKET

23.6 23.56 23.826.3


As this histogram shows, SNF ALOS was relatively evenly distributed for the reporting period.

SKILLED NURSING

A DISTRIBUTION OF SNF MEDICARE ALOS BY MARKET


COVID-19

With sudden office closures and restrictions on in-person visits, the healthcare industry had to adapt to sufficiently – and safely – treat their patients. As government regulations for practicing telehealth decreased and restrictions on office visits fell into place, patients and providers increasingly turned to telehealth to fill the healthcare gap. Unsurprisingly, telehealth claims skyrocketed, with claims leaping from 40,000 per month in Q1 2020 to 1,507,014 in April 2020. After the initial 3334% year-over-year increase, May and June telehealth claims declined month-over-month by 44.4% and 26.4%, respectively, as many states began to ease restrictions on in-person visits. Despite this drop, telehealth claims were still significantly higher in 2020 than in the previous year and are expected to remain so throughout 2021.

States with higher populations saw the highest number of telehealth claims. California, Texas, Florida, and New York had the highest number of telehealth claims, ranging between 218,400 and 333,900. Conversely, Vermont, North Dakota, Alaska, and Wyoming had the fewest claims, from between 3,400 and 6,800 claims.

At the beginning of 2020, the coronavirus pandemic hadn’t yet brought the world to a halt. However, when it did, the impact on the healthcare industry was immense. The next few charts and graphs illustrate how COVID-19 influenced FFS Medicare beneficiaries, physicians, and post-acute care organizations.

TELEHEALTH

MONTHLY TELEHEALTH CLAIMS, BENEFICIARIES, AND PHYSICIANS


Before exploring Q2 2020 trends for inpatient ALOS, it’s helpful to look at inpatient ALOS by market for Q2 2019 to create a baseline for comparison.

The ALOS for Q2 2019 ranged from 5.1 days (Wyoming) to 7.4 days (Washington, D.C.), with 31 states falling between 5.8 days and 6.4 days. The national ALOS was 6.1 days with a median of 6.0 days, reflecting a relatively even distribution.

COVID-19

A DISTRIBUTION OF INPATIENT ALOSBY MARKET: Q2 2019

COVID-19 IMPACT ON AVERAGE LENGTH OF INPATIENT STAY


COVID-19

This histogram also displays inpatient ALOS by market, updated to reflect data from Q2 2020. For this period, the ALOS range was relatively consistent with Q2 2019’s numbers, from a low of 5.2 days in Idaho to a high of 8.4 days in Washington, D.C. The average and median both increased from Q2 2019 values, from 6.1 days and 6.0 days to 6.6 days and 6.4 days, respectively. Aside from Idaho, which experienced a minimal decrease, all other markets experienced an increase in ALOS.

Initially, these results may seem counterintuitive. We might expect a decrease in ALOS, with providers attempting to move non-COVID-19 patients out of hospitals to reduce exposure and free up capacity for coronavirus cases. Further analysis of the available data can help provide a more complete view of COVID-19’s impact on ALOS.

A DISTRIBUTION OF INPATIENT ALOSBY MARKET: Q2 2020


COVID-19

COVID-19 patients represented 5.2% of inpatient stays in Q2 2020. This histogram shows a significant increase in ALOS for COVID-19 patients compared to the ALOS for all patients during the same period. Likewise, the average and median ALOS for COVID-19 patients in Q2 2020 were much higher than for all Q2 2020 patients. The mean increased from 6.6 days to 10.0 days, while the median rose from 6.4 days to 9.9 days.

ALOS ranged from a low of 7.3 days in Idaho to a high of 14.9 days in Florida.

Given this data, we can speculate about potential causes for COVID-19 patients’ impact on Q2 2020 ALOS. Increased length of stay could be in part due to:

• Initial lack of guidance for treating COVID-19 patients

• Time needed for doctors to try multiple therapies

• Severity of the illness and necessary recovery time

A DISTRIBUTION OF INPATIENT ALOS BY MARKET FOR COVID-19: Q2 2020


COVID-19

One of the main issues hospitals have when treating and triaging COVID-19 patients is the availability of beds and the length of time it takes to treat and discharge COVID-19 patients. The following charts compare ALOS for patients with other infectious diseases, such as tuberculosis and meningitis, versus COVID-19. For every state, the ALOS for COVID-19 patients during Q2 2020 was as long or longer than those with other infectious diseases from Q3 2019 to Q2 2020. The ALOS for COVID-19 patients varied significantly by state, running anywhere from 8.6 to 16.7 days, with the majority landing between 9 and 12 days.

ALOS: COVID-19 VS. INFECTIOUS DISEASES

A DISTRIBUTION OF INPATIENT ALOS BY MARKET FOR COVID-19 VS. OTHER INFECTIOUS DISEASES


COVID-19

ALOS for COVID-19 patients in skilled nursing facilities was almost identical to that of other infectious diseases. The range of SNF ALOS was larger for COVID-19 patients, with Arizona’s 16.4 days as the low and West Virginia’s 43.0 days as the high. While this contrasts to the ALOS range of 17.4 to 32.1 days for other infectious diseases, most states ranged from between 22 and 28 days for both categories.

A DISTRIBUTION OF SNF ALOS BY MARKET FOR COVID-19 VS. OTHER INFECTIOUS DISEASES


COVID-19

To accurately assess the inpatient mortality rate of COVID-19 cases, it’s helpful to compare against a diagnostic category that already has a significant mortality rate. This histogram shows the mortality rate per state for COVID-19 cases in Q2 2020 and other infectious diseases for Q3 2018 to Q2 2020. On average, COVID-19 had a much higher mortality rate than other infectious diseases. Only five states reported a mortality rate below 6% - South Dakota, Maine, North Dakota, New Hampshire, and Nebraska. In contrast, the mortality rate for infectious diseases, excluding COVID-19, was below 6% for nearly all states, except for Arkansas. The states with the lowest COVID-19 mortality rates also reported the lowest initial number of cases of the virus.

On the opposite end of the spectrum, Rhode Island had the highest rate of COVID-19 mortality at 17.7%, trailed by Pennsylvania and Ohio – each with a mortality rate near 15%.

A DISTRIBUTION OF INPATIENT MORTALITY BY MARKET FOR COVID-19 VS. OTHER INFECTIOUS DISEASES


COVID-19

At the onset of the pandemic, it was clear COVID-19 would rank high in terms of mortality rates by diagnostic category, and the data corroborates. As seen in this graph, the mortality rate for patients with COVID-19 was third, at 9.8%, just behind neoplasms and sepsis.

INPATIENT MORTALITY BY DIAGNOSTIC CATEGORY


Find us on social media for more industry data and updates.

Home Health Skilled Nursing

Health Systems ACOs

Hospice

ABOUT TRELLA HEALTH

Trella Health is the leading provider of actionable analytics for ACOs, health systems, and the post-acute care market. We believe that to thrive in healthcare today, who you choose to work with is everything—whether it’s your referral sources or your network partners. So, we analyze and standardize billions of data points from across the continuum of care, and provide the insights you need to identify, build, and manage the best partnerships for your business.

For more information on how Trella Health can help your organization, reach us at www.TrellaHealth.com/contact

https://www.linkedin.com/company/trellahealth/

https://www.facebook.com/trellahealth/

https://twitter.com/trellahealth

http://www.TrellaHealth.com/contact


APPENDIX

HOME HEALTH METRICS BY MARKET REFERENCE TABLEMarket Q1 2020 Admissions Q1 2019 Admissions Q1 '20 vs. Q1 '19 Change

in Admissions Home Health Utilization Home Health Adherence

National 908,007 957,520 -5.2% 29.3% 71.5%AK 739 649 13.9% 14.7% 69.0%AL 17,016 17,838 -4.6% 31.7% 74.4%AR 10,017 10,256 -2.3% 27.8% 76.6%AZ 14,300 14,415 -0.8% 26.6% 68.9%CA 103,764 105,601 -1.7% 32.8% 71.3%CO 8,602 9,659 -10.9% 25.8% 67.4%CT 12,883 13,507 -4.6% 37.0% 70.0%DC 964 999 -3.5% 23.0% 50.7%DE 4,233 4,128 2.5% 34.9% 73.4%FL 97,305 100,830 -3.5% 34.9% 72.8%GA 22,879 23,995 -4.7% 27.8% 70.5%HI 1,147 1,055 8.7% 17.3% 57.7%IA 6,000 6,277 -4.4% 20.2% 68.8%ID 4,158 4,098 1.5% 27.1% 78.3%IL 40,220 46,037 -12.6% 28.2% 70.8%IN 15,730 16,509 -4.7% 24.0% 72.7%KS 8,564 8,502 0.7% 24.2% 76.0%KY 14,572 16,124 -9.6% 27.8% 75.9%LA 14,372 15,144 -5.1% 28.2% 76.2%MA 33,036 34,831 -5.2% 38.8% 76.6%MD 19,551 19,647 -0.5% 31.0% 67.1%ME 4,518 5,149 -12.3% 34.1% 79.4%MI 30,032 36,809 -18.4% 29.6% 71.5%MN 9,285 9,772 -5.0% 19.9% 66.8%MO 15,340 16,180 -5.2% 26.6% 75.7%MS 15,312 15,470 -1.0% 30.9% 80.0%MT 1,542 1,764 -12.6% 14.5% 67.2%NC 28,819 30,975 -7.0% 29.2% 73.9%ND 1,088 1,055 3.1% 13.2% 66.3%NE 4,633 4,937 -6.2% 21.9% 74.1%NH 5,779 5,851 -1.2% 38.4% 80.4%NJ 23,729 24,992 -5.1% 29.5% 71.4%NM 4,237 4,597 -7.8% 24.3% 67.0%NV 9,146 9,203 -0.6% 31.2% 67.4%NY 44,279 45,525 -2.7% 28.8% 65.2%OH 25,150 32,560 -22.8% 25.5% 62.6%OK 15,337 15,914 -3.6% 29.5% 72.6%OR 6,500 6,319 2.9% 22.7% 69.8%PA 39,324 40,511 -2.9% 33.7% 76.0%RI 3,356 3,506 -4.3% 36.1% 77.3%SC 17,895 18,763 -4.6% 32.8% 74.1%SD 1,474 1,496 -1.5% 15.4% 72.5%TN 19,561 19,343 1.1% 27.8% 72.9%TX 63,307 66,881 -5.3% 28.8% 67.2%UT 6,647 7,034 -5.5% 33.0% 74.6%VA 27,747 28,580 -2.9% 32.9% 73.3%VT 3,300 3,367 -2.0% 34.6% 78.1%WA 13,054 13,195 -1.1% 22.3% 66.7%WI 10,046 10,164 -1.2% 21.7% 72.4%WV 6,428 6,406 0.3% 27.8% 72.9%WY 1,090 1,101 -1.0% 17.7% 68.3%


APPENDIX (continued)

HOSPICE METRICS BY MARKET REFERENCE TABLEMarket 2020 Q2 Admissions 2019 Q2 Admissions Q2 '20 vs. Q2 '19

Change in Admissions Hospice Utilization Hospice ALOS Hospice Adherence

National 353,496 352,410 0.3% 46.2% 79.5 90.9%AK 209 183 14.2% 23.3% 50 87.0%AL 7,101 7,531 -5.7% 48.0% 100 92.0%AR 3,560 4,168 -14.6% 52.7% 71 92.7%AZ 9,887 9,384 5.4% 56.3% 88 91.9%CA 36,309 34,768 4.4% 40.2% 90 92.4%CO 5,258 4,853 8.3% 48.0% 83 89.6%CT 3,976 3,793 4.8% 44.4% 60 87.6%DC 309 296 4.4% 25.7% 79 86.6%DE 1,364 1,369 -0.4% 55.9% 83 88.5%FL 30,278 31,092 -2.6% 58.8% 78 92.7%GA 11,363 10,972 3.6% 51.1% 92 91.9%HI 1,368 1,314 4.1% 44.0% 84 91.1%IA 4,166 4,358 -4.4% 55.2% 64 95.0%ID 1,937 1,964 -1.4% 49.0% 93 92.7%IL 13,131 12,248 7.2% 48.6% 70 92.4%IN 7,642 8,238 -7.2% 47.6% 75 91.9%KS 3,419 3,532 -3.2% 51.9% 82 91.8%KY 4,545 4,841 -6.1% 43.6% 53 92.8%LA 5,851 5,492 6.5% 46.3% 88 91.4%MA 7,473 6,926 7.9% 41.2% 78 88.1%MD 5,992 5,516 8.6% 45.7% 68 92.1%ME 1,802 1,949 -7.5% 48.0% 75 90.5%MI 12,396 12,704 -2.4% 46.8% 76 91.5%MN 6,357 6,008 5.8% 50.2% 76 93.3%MO 7,511 7,939 -5.4% 47.6% 77 91.0%MS 3,806 4,179 -8.9% 43.9% 96 91.8%MT 1,060 1,199 -11.6% 40.7% 67 89.4%NC 10,954 11,249 -2.6% 47.3% 75 89.3%ND 715 755 -5.3% 34.0% 65 82.6%NE 2,026 1,990 1.8% 46.0% 72 93.3%NH 1,429 1,316 8.6% 42.9% 74 89.6%NJ 9,312 8,069 15.4% 38.6% 67 91.7%NM 2,171 2,153 0.8% 44.4% 97 88.1%NV 3,209 3,146 2.0% 46.5% 75 91.8%NY 11,142 10,730 3.8% 23.1% 54 82.4%OH 16,804 16,833 -0.2% 54.4% 81 89.7%OK 4,839 5,325 -9.1% 46.3% 95 88.5%OR 4,885 4,741 3.0% 48.5% 65 90.4%PA 16,243 16,265 -0.1% 46.7% 70 91.0%RI 1,354 1,496 -9.5% 54.1% 73 89.3%SC 6,462 6,721 -3.9% 50.2% 85 89.3%SD 888 893 -0.6% 44.9% 54 92.7%TN 7,896 8,203 -3.7% 45.4% 80 91.8%TX 27,185 27,483 -1.1% 51.6% 92 90.3%UT 3,158 3,080 2.5% 55.0% 102 92.4%VA 7,964 8,024 -0.7% 46.0% 79 90.8%VT 707 675 4.7% 37.9% 94 90.4%WA 6,494 6,280 3.4% 40.1% 66 89.6%WI 7,003 7,377 -5.1% 54.1% 82 94.0%WV 2,194 2,435 -9.9% 43.6% 71 83.2%WY 392 355 10.4% 35.5% 35 88.4%


APPENDIX (continued)

SKILLED NURSING METRICS BY MARKET REFERENCE TABLEMarket 2020 Q2 Admissions 2019 Q2 Admissions Q2 '20 vs. Q2 '19

Change in Admissions SNF Utilization SNF 30-Day Readmission Rate SNF ALOS SNF Adherence

National 424,728 540,335 -21.4% 23.5% 15.0% 24.2 85.5%AK 210 249 -15.7% 7.5% 8.6% 28.4 77.2%AL 4,981 7,891 -36.9% 20.1% 14.3% 22.4 85.1%AR 4,870 5,840 -16.6% 20.5% 14.6% 24.4 82.9%AZ 5,027 7,165 -29.8% 18.8% 14.4% 21.8 89.1%CA 37,724 45,459 -17.0% 25.3% 15.8% 26.7 84.3%CO 4,289 6,066 -29.3% 22.3% 11.6% 22.9 88.9%CT 8,583 8,214 4.5% 30.6% 14.9% 22.1 85.9%DC 810 834 -2.9% 22.7% 13.6% 26.8 81.0%DE 1,413 1,990 -29.0% 20.1% 15.8% 25.6 85.9%FL 31,920 41,473 -23.0% 23.0% 16.3% 24.9 86.5%GA 8,651 11,230 -23.0% 18.6% 15.9% 24.5 82.1%HI 654 902 -27.5% 19.0% 11.1% 28.2 86.0%IA 5,482 7,470 -26.6% 27.1% 11.6% 18.6 90.7%ID 1,531 2,179 -29.7% 20.5% 9.2% 22.3 89.0%IL 20,443 27,836 -26.6% 26.6% 16.2% 24.1 84.0%IN 11,308 15,172 -25.5% 26.5% 14.6% 25.4 83.2%KS 5,456 7,826 -30.3% 27.0% 12.5% 20.1 88.6%KY 7,460 9,553 -21.9% 24.3% 15.1% 22.4 84.1%LA 8,354 7,350 13.7% 21.1% 15.6% 27.5 84.6%MA 17,674 17,202 2.7% 26.3% 15.0% 19.7 86.9%MD 9,827 13,336 -26.3% 26.5% 14.5% 26.1 85.1%ME 1,548 2,741 -43.5% 22.9% 11.3% 21.0 89.2%MI 13,208 18,042 -26.8% 23.7% 16.4% 21.7 85.5%MN 5,866 8,884 -34.0% 23.9% 12.8% 20.6 83.4%MO 8,580 12,051 -28.8% 23.3% 15.6% 22.4 85.7%MS 5,840 7,451 -21.6% 24.4% 15.1% 27.5 82.7%MT 1,372 1,851 -25.9% 20.2% 10.3% 21.1 86.2%NC 10,904 16,154 -32.5% 21.7% 14.7% 24.0 85.6%ND 1,317 1,752 -24.8% 24.6% 11.6% 19.8 81.5%NE 3,186 4,801 -33.6% 27.3% 11.4% 22.3 87.8%NH 1,908 2,776 -31.3% 23.4% 12.6% 23.1 87.2%NJ 19,640 21,709 -9.5% 30.5% 16.7% 23.7 88.3%NM 1,548 2,198 -29.6% 18.2% 14.9% 23.2 85.5%NV 2,567 3,363 -23.7% 19.5% 15.9% 25.0 85.8%NY 33,736 34,914 -3.4% 26.3% 15.5% 28.7 85.5%OH 16,486 22,762 -27.6% 25.7% 15.6% 23.7 84.0%OK 5,899 7,889 -25.2% 21.3% 15.2% 24.0 88.8%OR 2,370 3,999 -40.7% 18.4% 12.8% 23.3 89.5%PA 18,243 22,997 -20.7% 23.7% 14.3% 20.3 84.5%RI 1,337 1,848 -27.7% 29.3% 14.9% 20.1 87.1%SC 6,134 7,590 -19.2% 18.4% 15.5% 25.1 82.2%SD 1,588 2,327 -31.8% 25.9% 11.2% 20.0 89.0%TN 8,579 12,306 -30.3% 23.2% 14.5% 26.4 87.2%TX 28,538 33,245 -14.2% 21.0% 15.3% 25.3 84.7%UT 2,205 3,066 -28.1% 23.0% 9.8% 24.6 88.8%VA 9,793 14,891 -34.2% 21.3% 15.0% 24.7 87.7%VT 906 1,478 -38.7% 22.5% 12.4% 21.5 85.5%WA 5,473 8,883 -38.4% 20.8% 13.1% 25.5 87.6%WI 6,495 8,854 -26.6% 23.4% 13.2% 23.6 85.9%WV 2,085 3,269 -36.2% 19.9% 14.8% 21.9 83.6%WY 710 1,007 -29.5% 19.7% 10.3% 25.2 86.1%

Industry Trend Report


Documents

Industry Trend Report 20