The Importance of Post-Acute Care

Las Vegas—Studies have shown that patients who receive post-acute care following a major medical event have improved clinical outcomes compared with patients who are discharged without follow-up care. Post-acute care can take place in settings such as skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals, and delivered by home health agencies in the patient’s home.

Because the aging population continues to increase, the demand for post-acute care services is important, and the growth of post-acute care spending has become a focus for the Centers for Medicare & Medicaid Services.

Neil M. Pressman, FACHE, principal, Baker Tilly, discussed the importance of post-acute care, particularly for optimizing health outcomes, reducing healthcare spending, and improving the healthcare delivery system during a session at the NAMCP forum.

Upon discharge from acute care, patients should be assessed for:

• Clinical comorbidities
• Complications
• Functional status/cognitive ability
• Post-hospital care required (facility, professional)
• Family support
• Home environment
• Patient preferences
• Insurance coverage/patient financial capacities

Mr. Pressman acknowledged that acute care hospital and post-acute care provider coordination is essential to improving quality of care and reducing spending. Under the Patient Protection and Affordable Care Act (ACA), Medicare has implemented penalties for hospital readmissions occurring within 30 days of discharge. Despite this, Medicare data indicates that more than half of readmitted patients receive no care or follow-up 30 days post-hospitalization. Medicare national hospital readmission 30 days post-discharge is approximately 20%, of which an estimated 76% could be preventable [N Engl J Med. 2009;360(14):1418-1428].

The ACA has established transitional care programs and services and provides $500 million from 2011 to 2015 to health systems and community organizations that provide at least 1 transitional care intervention to high-risk Medicare beneficiaries. The ACA also created a Center for Medicare and Medicaid Innovation to test new payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care. It provides $10 billion from 2011 to 2019 and each subsequent 10-year period beginning in 2020.

Additional programs established to support care transitions include:

• Medicare Shared Savings Programs: Medicare accountable care organizations (ACOs) must submit performance data addressing care transitions across healthcare settings
• Patient-Centered Medical Homes: Designed to provide comprehensive care management to patients with chronic conditions
• Bundled Payments: Test integrated, episode-based payments and care delivery models, including transitional care

Mr. Pressman noted the ways in which post-acute care can reduce healthcare spending, including lower costs per-patient, per-day relative to inpatient acute care; reduced avoidable hospital readmissions; avoidance of unnecessary emergency department (ED) care; delivery of medically appropriate care along the continuum of care; and improved quality of healthcare outcomes.

The needs for collaboration between hospital and post-acute care providers include hospital discharge planning requirements, readmission penalties, and ACOs; concern from post-acute care facilities regarding patients discharged to facilities with care needs that exceed their capabilities; and concerns from hospitals regarding post-acute care providers inappropriately sending patients back to the ED.—Kerri Fitzgerald