Prevalence Rates and Characteristics of Malnutrition, Frailty, and Other Nutrition and Muscle Mass-Related Conditions Document Potential Quality of Care Gap for Medicare Patients in US Skilled Nursing Facilities

Abstract

Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics.

The Impact of Malnutrition on Skin Integrity and Wound Healing

“…11 The prevalence of malnutrition in post acute care can be as high as 50%. 12 The risk for malnutrition and/or diagnosis of malnutrition is associated with polymorbidities, frailty, impaired mobility, sarcopenia, facility-acquired infections and other complications, an increased risk for pressure injuries (PIs), and slow healing of all types of wounds. [13][14][15]…”

“…Once hospitalized, between 30% and 38% of well-nourished patients experience a decline in nutrition status during the hospitalization, 10 and 26% of patients had lost weight 1 month after hospital discharge 11 . The prevalence of malnutrition in post acute care can be as high as 50% 12 . The risk for malnutrition and/or diagnosis of malnutrition is associated with polymorbidities, frailty, impaired mobility, sarcopenia, facility-acquired infections and other complications, an increased risk for pressure injuries (PIs), and slow healing of all types of wounds 13–15 …”