Incentives for Access: Changes in Admissions and Care Delivery for Metastatic Cancer Patients in Medicare Skilled Nursing Facilities, After the Patient-Driven Payment Model

BackgroundCancer patients experience suboptimal care in skilled nursing facilities (SNFs). Medicare's Patient-Driven Payment Model (PDPM) incentivized SNFs to admit complex patients, potentially promoting admissions without appropriate changes in care delivery.ObjectiveTo evaluate changes in SNF admissions, rehabilitation therapy volume, and chemotherapy/radiation around admission or discharge, following PDPM and COVID-19.MethodsAdjusted interrupted time series examining 1,125,782 hospital stays from metastatic cancer patients, using 100% Traditional Medicare claims (2018-2021).ResultsPDPM was associated with increased SNF admissions (0.47 pp/month; 95% CI: [0.17, 0.76]) and an immediate reduction in therapy volume (-24.95 minutes per day, 95% CI: [-26.40, -23.48]). Chemotherapy use remained low, but increased by 21% at PDPM implementation, without subsequent slope change (RR: 1.21; 95% CI: [1.01, 1.46]); radiation was unchanged. COVID-19 reversed admission gains. SNF admissions for metastatic cancer patients increased without sustained changes in cancer-relevant care delivery, warranting investigation of health outcomes and outcome-driven policy.