Journal of the American Medical Directors Association
September 18, 2026 · via Europe PMC
Institutional Post-Acute Care Use After Hospitalization by Medicare Type, 2017-2022.
Park J, Poyraz E, Startup J
AI summary — for doctors, generated from the abstract only
A large national analysis found Medicare Advantage beneficiaries were much less likely than Traditional Medicare beneficiaries to be discharged to inpatient rehabilitation facilities after hospitalization, with higher in-facility mortality among MA patients in IRFs but lower in-facility mortality among MA patients in skilled nursing facilities.
What was studied
A retrospective cohort study using publicly available aggregate Medicare utilization data (2017-2022) comparing discharge rates to inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF) after short-stay hospitalization, and associated in-facility mortality, community discharge, and 30-day readmission, between Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, using year-adjusted Poisson and logistic regression.
Key findings
- MA beneficiaries had much lower discharge rates to IRF than TM beneficiaries (incidence rate ratio 0.397, 95% CI 0.395-0.398), with a smaller difference for SNF (IRR 0.904, 95% CI 0.903-0.905).
- Within IRF, in-facility mortality odds were much higher for MA beneficiaries (OR 14.69, 95% CI 14.21-15.18); within SNF, in-facility mortality odds were lower for MA beneficiaries (OR 0.447, 95% CI 0.444-0.450).
- Across both payers combined, mortality was lower in IRF than SNF (0.71% vs 2.46%; OR 0.28, 95% CI 0.278-0.286), described as statistically significant (exact p-value not available in the provided abstract text, which appears truncated).
Clinical relevance
The findings suggest meaningful differences in post-acute care access and outcomes by Medicare payer type, which may be relevant to policymakers and clinicians involved in discharge planning; the authors explicitly note patient-level case-mix data are needed to determine whether these differences persist after adjusting for underlying patient severity.
Who should care
Limitations
Aggregate (not patient-level) Medicare utilization data without case-mix adjustment, which the authors explicitly state is needed to determine whether the observed differences reflect true disparities versus differences in patient severity between MA and TM populations referred to each setting.
Medicare Advantage beneficiaries are discharged to inpatient rehabilitation facilities far less often than Traditional Medicare beneficiaries after hospitalization, with notable differences in in-facility mortality that require further case-mix-adjusted study to interpret.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
OBJECTIVES
To compare national discharge to inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF) after short-stay hospitalization among Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries.
DESIGN
Retrospective cohort study using publicly available aggregate Medicare utilization data.
SETTING AND PARTICIPANTS
Participants included United States MA and TM beneficiaries from 2017 to 2022.
METHODS
Primary outcomes were discharge rates to IRFs and SNFs per 1000 acute hospital discharges and in-facility mortality. Secondary outcomes included community discharge and 30-day readmission among TM beneficiaries. Year-adjusted Poisson regression with acute discharges as an offset estimated incidence rate ratios (IRRs) comparing MA and TM utilization. Discharge-weighted logistic regression estimated odds ratios (ORs) for mortality, community discharge, and readmission. Trends in IRF vs SNF utilization were evaluated using year-adjusted logistic regression.
RESULTS
Compared with TM beneficiaries, MA beneficiaries had lower discharge rates to IRF (IRR, 0.397; 95% CI, 0.395-0.398), with a smaller difference for SNF (IRR, 0.904; 95% CI, 0.903-0.905). Within IRF, in-facility mortality odds were higher for MA beneficiaries (OR, 14.69; 95% CI, 14.21-15.18). Within SNF, in-facility mortality odds were lower for MA beneficiaries (OR, 0.447; 95% CI, 0.444-0.450). Across both payers combined, mortality was lower in IRF than SNF (0.71% vs 2.46%; OR, 0.28; 95% CI, 0.278-0.286; P < .001). Among TM beneficiaries, discharge to IRF was associated with lower odds of 30-day readmission (OR, 0.76; 95% CI, 0.75-0.76) and higher odds of community discharge (OR, 1.84; 95% CI, 1.83-1.85).
CONCLUSIONS AND IMPLICATIONS
MA beneficiaries had lower downstream use of IRF after hospitalization than TM beneficiaries. In-facility mortality differed among post-acute settings and payer. Patient-level case-mix at the referral source is needed to evaluate whether these differences persist after case mix adjustment.
DOI
10.1016/j.jamda.2026.106491
PMID
42759325
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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