Key Findings

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  • The sharp drop in hospital utilization during the early weeks and months of the pandemic left many systems short on cash as elective care was deferred.
  • From fiscal year (FY) 2018 through FY 2021, the share of hospitals participating in Medicare’s Value-Based Purchasing Program with a Total Performance Score of 50 or greater fell, to 9.3% from 13.6%.
  • In 2020, 68.2% of diabetes mellitus and 65.9% of atrial fibrillation cases were outpatient—a decrease of 3.8 and 3.6 percentage points, respectively, from 2018.
  • After a slight decline in 2018, the average overall rating for all hospitals reported on Care Compare cumulatively increased in 2019, to 3.22 stars, the highest overall rating for the years shown.


  • After growing by an average of 4% annually from 2015 to 2019, consumer spending on physician office services dropped by 6.5% in 2020, as patients deferred care in response to the COVID-19 pandemic.
  • From 2018 to 2019, all regions across the U.S. saw a slight decline in the percentage of Type 2 diabetes patients with poorly controlled A1c levels (above 9.0%)—a 0.9-point dip for the nation.
  • From 2017 through 2019, the share of Type 2 diabetes patients in Austin, Texas, with an A1c >9.0% was higher for such patients with depression than it was among the overall Type 2 diabetes population.
  • The share of rheumatoid arthritis (RA) patients in the U.S. who received an opioid analgesic declined notably to 40.5% (in 2019) from 45.8% (in 2017) and was highest, by region, in the South in both years.


  • For the third year in a row, the number of accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) fell, to 477 in 2021 from 561 in 2018.
  • In performance year (PY) 2019, the average MSSP ACO earned $2.4 million in shared savings payments from Medicare, a boost of 33.5% from the
    PY 2018 mean.

Long-Term Care

  • In 2020, nursing care facilities shed 9.4% of jobs, while consumer spending on nursing home services fell by 6.2%, in large part due to the
    COVID-19 pandemic.
  • From Q3 2019 to Q2 2020, emergency department visits and rehospitalizations for short-stay nursing home residents were both highest, by division, in the West South Central: 10.8% and 23.4%, respectively.
  • Total charge and Medicare payment amounts per skilled nursing facility nationwide declined from 2016 to 2018—the average Medicare charge dipped by around $74,000.
  • At least a quarter of Medicare beneficiaries receiving home health in each of the profiled states in 2018 were diagnosed with atrial fibrillation (AFib).


  • Telehealth utilization grew dramatically within the past year—soaring from less than 1% of all community health center visits in 2019 to a peak of more than half of such visits by the spring of 2020, before settling at around 27% in mid-October.
  • Before the pandemic, telehealth offerings in fee-for-service Medicare were limited mostly to visits provided outside the home and in rural settings; Medicare Advantage plan sponsors could offer much broader access.

COVID-19 Crisis

  • December 2020 saw Emergency Use Authorizations issued for two COVID-19 vaccines. As of the first week of February 2021, however, less than 10% of most states’ populations had received a vaccine dose.
  • Both of the initial COVID-19 vaccines authorized in the U.S. require a two-dose regimen, raising the logistical burden and leading to low rates of administration, as some distributed doses were held in staging as second doses.
  • After more than quadrupling from September to December of 2020, weekly COVID-19 case counts for residents and staff at nursing facilities in the U.S. peaked at 33,621 and 28,662, respectively.
  • The subsequent fall in the number of weekly cases among residents and staff at nursing facilities in the U.S. coincided with a rise in the cumulative number of whom received the two-dose vaccine as part of the Pharmacy Partnership for Long-Term Care Program.
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