How Much is Post-Acute Care Use Affected by Its Availability?

Does how much and how you pay matter? Evidence from the inpatient rehabilitation care prospective payment system

“…The clinical variables also included 21 types of complications that were likely to have arisen during the acute stay, be important for a Medicare population, and have a continued effect after acute care discharge: pulmonary compromise; post-operative gastrointestinal hemorrhage; cellulitis or decubitus ulcer; septicemia; pneumonia; mechanical complications due to a device; implant, or graft; shock or cardiorespiratory arrest in the hospital; post-operative acute myocardial infarction (AMI); post-operative cardiac abnormalities other than AMI; post-operative derangement; coma; procedure-related perforation or laceration; venous thrombosis and pulmonary embolism; wound infection; acute renal failure; delirium; sentinel events; iatrogenic complications; stroke (for joint replacement and hip fracture patients only); hip fracture (for stroke patients only); and other miscellaneous complications (Iezzoni et al, 1994;Buntin et al, 2005).…”

“…The models also included a large set of clinical variables tailored to our stroke, hip fracture, and joint replacement patients intended to control for the severity of each patient at discharge from the acute care hospital. The clinical variables included the following 13 chronic comorbidities: primary cancer with poor prognosis, metastatic cancer, chronic pulmonary disease, coronary artery disease, congestive heart failure, peripheral vascular disease, severe chronic liver disease, diabetes mellitus with and without end-organ damage, chronic renal failure, nutritional deficiencies, dementia, and functional impairment (Iezzoni et al, 1994;Buntin et al, 2005).…”

Medicare Post-Acute Care Episodes and Payment Bundling

“…About one third of beneficiaries go on to use Medicare PAC services after acute hospital discharge and use a variety of services across a continuum of provider settings during the 30 days after acute hospital discharge (Gage, Morley, Ingber, & Smith,, 2011;Morley, Gage, Smith, Spain, & Ingber, 2009). Another complexity in PAC service delivery is that the supply of Medicare providers differs across the U.S.; therefore, beneficiaries with similar clinical characteristics receive services from different types of PAC providers, depending on the provider supply in a region (Buntin et al, 2005). The geographic variation in the use of PAC services is significant.…”

Did the Medicare Inpatient Rehabilitation Facility Prospective Payment System Result in Changes in Relative Patient Severity and Relative Resource Use?

“…To avoid confounding due to changes in coding that are endogenous to the IRF PPS implementation, we defined these 3 groups using information from the preceding acute care stay (Table 1). 13 We fit a logistic regression model to each outcome measure using 2002 data to obtain the predicted outcome measure for the 1999 cases.…”