An All-Payer View of Hospital Discharge to Postacute Care, 2013

Excerpt

Following hospitalizations for injury or illness, many patients require continued postacute care (PAC) to support recovery, improve functional status, or manage chronic illness. PAC includes a range of medical services such as rehabilitation care, skilled nursing care, and palliative care. In 2014, PAC was provided in 1,177 inpatient rehabilitation facilities (IRFs), 422 long-term care hospitals (LTCHs),15,173 skilled nursing facilities (SNFs), and at home through 12,461 home health agencies (HHAs). The four types of PAC settings overlap considerably in the conditions treated. However, each type of setting specializes in a specific array of care and therapies with different staffing, costs, and outcomes. About 42 percent of Medicare fee-for-service (FFS) patients were discharged to a PAC setting after hospitalization in 2013. Between 2001 and 2013, Medicare spending on PAC, both facility-based and in-home, doubled from $29 billion to $59 billion per year and has grown faster than most other major Medicare spending categories.

Hospital discharge planning plays a key role in shaping downstream PAC use in terms of the numbers and types of patients discharged to different PAC settings. However, no clear clinical guidance exists to determine the type of PAC setting to which a patient with a specific condition should be discharged. Discharges to PAC often are driven by the availability of specific types of settings and by financial incentives that are not always aligned with clinical needs and may not be cost-effective. Current studies on discharges to PAC are based on either Medicare FFS patients using Medicare claims data or small clinic-based cohorts using primary data collection. To date, there are no estimates of discharges to PAC based on a national all-payer dataset that can offer a complete picture including not only Medicare FFS but also other payers.

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on hospital discharges to PAC settings in 2013 from an all-payer view. Using the 2013 National Inpatient Sample (NIS), this Statistical Brief estimates discharges to PAC for all types of payers and describes these discharges from the perspective of payers, patients, hospitals, conditions/procedures, and geographic regions. Discharges to PAC in this Statistical Brief are defined as those discharges to IRFs, LTCHs, SNFs, or home with HHA services. Discharges to outpatient PAC facilities and inpatient stays in Veterans Health systems are not included because data are not available in the NIS. All differences between estimates noted in the text are statistically significant at the .01 level or better.