Episode-based payment models are increasing in popularity for surgery. Health systems aiming to improve surgical episode efficiency should focus on working with patients to choose the highest value PAC setting. In this context, the Centers for Medicare and Medicaid Services CMS are holding csre accountable for care that occurs after discharge. In the Hospital Value-based Purchasing Program HiwCMS is penalizing hospitals that spend more than their peers on episodes of care that start 3 days prior to hospital admission and end 30 days after discharge 6. In each of these programs, participating hospitals can accept payments for longitudinal, condition-specific episodes of care that include PAC. While hospitals have been charged with identifying ways to decrease PAC spending, factors responsible for current variation in PAC spending are incompletely understood. After major inpatient surgery in older adults, hospitals have a range of choices regarding post-discharge care. Patients may be discharged without services; with home health care with or without outpatient physical therapy; or with inpatient skilled nursing or rehabilitation. Despite vastly different costs attributable to these services, there are little clinical outcomes data to guide decision-making around choice of post-acute care setting or intensity of services in a given setting. Furthermore, how discharge decisions impact post-acute care spending for surgical conditions has not yet been fully defined.
Pexels CC0. In the current post-acute care landscape, hospitals reign supreme, helping to decide the fates of the players farther down the care continuum. Reach out to aspanko agingmedia. I was meeting with the senior leadership of large health care system to discuss post-acute strategy. We start talking about what types of patients that can leave the hospital sicker and quicker. That could work. And then we start describing some patients who are going to LTACs or acute rehabs. We agree. The federal government to come in and really design a new reimbursement system. I feel bad for the hospitals, because they need to make a living.
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Post-acute care PAC includes rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital. Depending on the intensity of care the patient requires, treatment may include a stay in a facility, ongoing outpatient therapy, or care provided at home. The Commission analyzes trends in care and spending in PAC settings and makes recommendations to the Congress and the Medicare program. Medpac Advising the Congress on Medicare issues. Post-Acute Care Post-acute care PAC includes rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital. Narrow your results within this research area using the filters on the left. You can also sort your results using the drop-down boxes on the right. Filter Your Selections:. Showing 1 — 10 out of Year: select ALL
IRC & Physiatry; Optimizing Post-Acute Care
After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix. Most of them got those services after coming out of the hospital. Some of these providers earn double-digit profits from Medicare through a hodgepodge of payment methods that health experts say encourages unnecessary and disjointed care, wastes taxpayer money and makes fraud easier. More than a quarter of Medicare spending in Louisiana, Texas, Mississippi, Oklahoma and Massachusetts was for post-acute care inMedicare records. Hospitals are often the gatekeepers to this world. Largely it has to do with the supply of providers and type of providers in the area. How do post acute care facilities make money Parente, a health care economist at the University of Minnesota, says the changes are likely to upend much of the industry. Ironically, the growth of the post-hospital industry can be traced back to actions Medicare took in the s to clamp down on long inpatient hospital stays. Medicare started paying hospitals set sums for each patient stay, giving them a financial impetus to discharge patients as soon as possible. New services sprung up in response around the country to take these patients, often with business models that sought to maximize the money they could earn from Medicare. Those robust enough to return home can receive intermittent visits from nurses, physical therapists and aides who monitor their condition and assist in basic tasks. These services are known as home health. Patients needing closer oversight can end up in nursing homes or the more intense inpatient rehabilitation facilities, where people suffering strokes, major joint replacements and fractures often end up. The sickest patients, such as those who need ventilators to breathe for weeks, may be admitted to long-term care hospitals, where the average stay is 26 days. Medicare pays each type of facility different rates — even when they are treating the same kinds of patients.
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