Association Between the Patient-Driven Payment Model and Therapy Use, Patient Outcomes, SNF Expenditures, and Postacute Care Use Among Skilled Nursing Facility Beneficiaries by Dual Eligibility

Medicare and Medicaid dual-eligible beneficiaries (i.e., dual eligibles) have complex care needs and often experience poor outcomes in skilled nursing facilities (SNFs). The newly implemented patient-driven payment model (PDPM) changed SNFs' postacute care delivery model and may differentially impact dual eligibles. This study describes the trend breaks due to the PDPM on therapy use, patient outcomes, SNF expenditures, and postacute care use, by dual eligibility status. We utilized health care administrative data and regression discontinuity analysis to examine the change in outcomes among 2 million SNF beneficiaries. We found that dual eligibles experienced greater increases in SNF expenditures than Medicare-only beneficiaries ($771.4 vs. $418.5). No meaningful differences were observed in the change in quality or postacute care use patterns. The increase in SNF expenditure could be due to upcoding or comorbidities not accounted for previously. Our results illustrate the heterogeneous effects of the PDPM.