Background Cancer 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. Objective To evaluate changes in SNF admissions, rehabilitation therapy volume, and chemotherapy/radiation around admission or discharge, following PDPM and COVID-19. Methods Adjusted interrupted time series examining 1,125,782 hospital stays from metastatic cancer patients, using 100% Traditional Medicare claims (2018–2021). Results PDPM 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.
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Amaravadi et al. (2026) studied this question.
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