The authors set forth a foundation on which to build further dialogue and evidence to highlight occupational therapy’s distinctive contribution, significance, and viability as health care policies shift to focus on quality and value.

Background:The purpose of this paper is to examine service use in an episode of acute and post-acute care (PAC) under alternative episode definitions and to look at geographic differences in episode payments. Data and Methods:The data source for these analyses was a Medicare claims file for 30 percent of beneficiaries with an acute hospital initiated episode in 2008 (N = 1,705,794, of which 38.7 percent went on to use PAC). Fixed length episodes of 30, 60, and 90 days were examined. Analyses examined differences in definitions allowing any claim within the fixed length period to be part of the episode versus prorating a claim extending past the episode endpoint. Readmissions were also examined as an episode endpoint. Payments were standardized to allow for comparison of episode payments per acute hospital discharge or PAC user across states. Results:The results of these analyses provide information on the composition of service use under different episode definitions and highlight considerations for providers and payers testing different alternatives for bundled payment.

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Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings. KeywordsHealth care reform; Medicare; Prospective payment system; Rehabilitation; Treatment outcomes THE ISSUES DISCUSSED at the State-of-the-Science Symposium held in February 2007 and in the November 2007 issue of Archives are key to the development of sound health policy. We lack an instrument that allows us to compare patient outcomes across postacute care (PAC) settings in an evidence-based manner. This instrument is needed to measure the relative value of rehabilitation and medical services delivered by PAC providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), home health agencies (HHAs), and outpatient settings. As the differences in staffing and care practices become blurred across the different types of

A regression model with 16 casemix groups restricted to using "appropriate" payment variables (i.e., those with clinical face validity and low administrative burden that are easily validated and provide proper care incentives) produced more efficient and equitable payments than did a noninteractive system based on diagnosis-related groups.