# The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults

> **NIH NIH K23** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2021 · $98,379

## Abstract

PROJECT SUMMARY
 The COVID-19 pandemic has been devastating for nursing homes in the US. In response to the
unprecedented threat posed by the pandemic, Medicare required SNFs to impose a number of measures to
reduce the spread of COVID-19, including a ban on outside visitors. One consequence of this lockdown was
an overnight transformation of the nature of care delivery in SNFs. Specifically, Medicare waived long-standing
requirements around physician evaluation for SNF residents, including new flexibility for all SNFs to provide
care remotely via telehealth, previously restricted to rural SNFs under specific conditions.
 Telemedicine has long been regarded as a promising innovation in care delivery for SNFs, whose
residents have significant medical needs and impaired mobility. Unfortunately, adoption has been limited. The
barriers to telemedicine use in SNFs are not clinical, but primarily misaligned financial incentives. Telemedicine
requires investment in technology, training and culture change, but comes with little additional reimbursement.
The COVID-19 pandemic dramatically changed the clinical motivation for SNFs to use telemedicine and the
financial incentives for physicians to provide those services.
 Little is known about how SNFs have used telemedicine after COVID-19 emerged. There are many
evidence gaps, such as understanding the extent of telemedicine adoption in SNFs, what services are
delivered through virtual care, which sorts of physicians deliver them, and what factors contribute to variation in
telemedicine use. Answers to these questions are necessary to advance policy for future reimbursement and
use of this technology in SNFs moving forward.
 The objective of this K23 supplement is to characterize the adoption and use of telemedicine in SNFs
for the care of COVID-19 and non-COVID clinical care. My overarching hypothesis is that the COVID-19
pandemic has vastly accelerated telemedicine adoption in SNFs for both COVID-19 treatment and other
clinical care, especially at facilities with COVID-19 outbreaks. I propose two Aims:
 1) Characterize the adoption and use of telemedicine for COVID-19 treatment in SNFs with COVID-19 cases
 and variation by patient, facility and geographic characteristics.
 2) Characterize the delivery of all non-COVID-19 clinical care in SNFs with differing levels of telemedicine use
 before and during the COVID-19 pandemic.
 These Aims will provide detailed insight into how SNFs have adapted care delivery under
unprecedented circumstances. Evidence on telemedicine adoption at SNFs can inform the future of Medicare
regulation, state and federal investment in SNF telemedicine and the design of payment policy during future
waves of COVID-19.

## Key facts

- **NIH application ID:** 10253539
- **Project number:** 3K23AG058806-04S1
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** Michael Lawrence Barnett
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $98,379
- **Award type:** 3
- **Project period:** 2018-04-01 → 2023-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10253539

## Citation

> US National Institutes of Health, RePORTER application 10253539, The Changing Landscape of Post-Acute Care and Health Outcomes for Older Adults (3K23AG058806-04S1). Retrieved via AI Analytics 2026-08-12 from https://api.ai-analytics.org/grant/nih/10253539. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*