Aphasia among Medicare fee for service beneficiaries: initial encounter for services and discharge disposition

Background Studies report that 25–50% of stroke survivors in the United States experience aphasia. This study aimed to characterize where services for aphasia were initiated and the discharge disposition among fee-for-service (FFS) Medicare beneficiaries.Methods Data included 100% of FFS Medicare claims for Home Health Agency (HHA), Skilled Nursing Facility (SNF), Inpatient, Outpatient, and Carrier files. The sample included Medicare beneficiaries who incurred an inpatient claim between January 1, 2016 and October 1, 2019 with stroke as the primary diagnosis.Results We identified 745,917 unique FFS Medicare beneficiaries with a primary stroke diagnosis; 90% were over age 65. Approximately 79% were non-Hispanic White, 12% were non-Hispanic Black, and 6% were Hispanic. Among all patients with a stroke hospitalization, 14.5% were diagnosed with aphasia within 90 days, with racial/ethnic variations. Between 50% and 55% of people with aphasia (PWA) had their initial encounter in an inpatient hospital facility, 15%-20% in a skilled nursing facility, and 8%-12% in a rehabilitation facility. Roughly 10–15% of PWA were discharged home, 30% to a skilled nursing facility, 40% to a long-term care/rehabilitation center, and 10% to home health. A smaller percentage of non-Hispanic Black PWA (9.9%) were discharged home compared to non-Hispanic White PWA (13.6%). Similarly, a slightly larger portion of non-Hispanic Black PWA were discharged to a long-term care/rehabilitation facility (41.4%) than their non-Hispanic White PWA counterparts (40%).Conclusions The rate of aphasia remained relatively unchanged across the four-year period evaluated. Initial encounters for their aphasia varied across settings and the locations to which they were discharged after their acute care stay.