Hospice Saves Costs for Families: Evidence from 16 Years of Medicare Survey Data

Abstract

2020 (6 months before and after the requirement was waived), to understand the impacts of this waiver for veterans with OUD. Population Studied: We examined prescription information from the VA Corporate Data Warehouse for 42,579 Veterans diagnosed with OUD (91.6% male, 71% white, 16.8% black, 27% rural dwelling). Principal Findings: During this 12-month window, 56.6% of the sample were prescribed suboxone, 53.6% were prescribed sedatives, and 13.8% were prescribed anxiolytics. Monthly an average of 33,323 (SD = 3190) prescriptions were filled, with an average of 1.45 (SD = 0.08) medications prescribed per visit. As expected, the largest dip was seen in April 2020, with only 28,376 prescriptions filled, with an 1.33 prescriptions written per visit. As of August 2020, the rates for prescriptions for controlled substances had not returned to pre-COVID levels. Conclusions: These data suggest that while telehealth is a legal option to appropriately prescribe controlled substances, it was not utilized in a way that replicated in person care. Future projects that focus on understanding and addressing barriers providers face when attempting to provide care via telehealth are an important next step. Additionally, there was no dramatic increase in prescriptions for controlled substances as a result of the Ryan Haight waiver. Implications for Policy or Practice: These data support keeping the wavier of in person appointments in the Ryan Haight Act is one useful avenue to help providers to provide access to life saving MOUDs. Health Resource Files from Health Resources and Services Administration , and the New York Times county-level COVID-19 data. We plotted the proportion of NHs with at least one COVID-19 case, one related death, and four types of staff shortages (aides, licensed nurses, medical providers, and other staff) by rural/urban status from 5/25/20 to 2/28/21 to visualize the weekly trends over time. Then, weekly data were combined into four periods with 10 weeks of the aggregated data in each period. Our main analyses estimated the likelihood of having at least one case of COVID-19 infection, related death, or at least one week of staffing shortage in rural NHs compared to urban NHs over four time periods using generalized linear mixed models with state-fixed effects. Population Studied: We identified a total 59,515 aggregated cases combined from all four periods, involving 15,139 unique NHs that submitted at least one-week report during the study period. Principal Findings: Findings suggest that staffing shortage trends varied by both time and location. Rural areas experienced an increasing proportion of NHs with staffing shortages until mid-November, 2020, and then a gradual decrease afterwards, corresponding with trends in COVID-19 cases. Conversely, the proportion of NHs reporting staffing shortages in urban areas was relatively stable over time. The interaction effect between period and rural/urban status in adjusted models revealed a significantly higher likelihood of having at least one COVID-19 case, related death, and shortages in aides, licensed nurses, and other staff in rural NHs in later periods than in the earlier one, compared to changes in urban NHs over time. The proportion of NHs with medical provider shortage was about 10% which was lower than other types of staff shortages and unchanged during the study period in both rural and urban NHs. Conclusions: Our findings suggest that direct care provider staffing shortages in rural NHs were greatly accelerated over time with a surge in COVID-19 cases. Implications for Policy or Practice: The COVID-19 pandemic may have significantly strained rural NHs that are already burdened with healthcare human resource infrastructural deficits. Findings highlight the needs to develop effective strategies that maximize rural NH workforce crisis resilience, including enhanced recruitment and retention incentives, and targeted resource allocation to prepare for short-and long-term consequences of natural disasters such as COVID-19 pandemic.