Choice of Inpatient Vs. Home or Outpatient Care Drives Post-Acute Spending

Doctors sign the hospital discharge papers thousands of times a day for patients who have just had surgery, and send them off to their next destination. About half of those patients will get some sort of post-surgery care to help them heal and get back into life. But a new study finds huge variation in where they end up, depending on where they had their operation. And that variation in turn leads to huge differences in how much their care costs, the research shows.

The study, published in Health Affairs by a University of Michigan team, looks at the impact of sending patients home with some in-house or outpatient help, compared with sending them to a skilled nursing facility or an inpatient rehabilitation center.

The researchers looked at the type and cost of post-hospital care received by hundreds of thousands of patients covered by traditional Medicare in the 90 days after they had one of three common operations: hip replacement, heart bypass surgery, or removal of a part of their colon, called colectomy. They divided patients up by which hospital they had their operation at, and looked over a three-year period at how those hospitals compared.

Some hospitals, they found, had average post-acute care costs for a surgical patient that were three times as high as other hospitals. But after the researchers looked closer at where each of those hospitals tended to send their patients, those cost differences shrank markedly.

In the end, a hospital's decision to send a post-surgery patient to an inpatient rehabilitation facility was the key driver of total 90-day post-hospital costs. To a lesser extent, the decision to send the patient to a skilled nursing facility also drove costs, compared with prescribing in-home care or outpatient rehabilitation.

Doctors have little official guidance or objective measurements to help them decide which patients will do best in each setting, says Lena Chen, M.D., the lead author of the study and an assistant professor at the U-M Medical School.

Advertisement

"Based on these findings, and others, we can see that it's going to be really important to find out which type of care setting will have value to which patients, and when," she says. "We need to better understand how to do what's best for each patient."

The need for such tools is even more important now, because hospitals are increasingly being penalized or rewarded financially by Medicare for the total cost of their surgical patients' care - even in the weeks after the patient leaves the hospital.

Advertisement

Accountable care organizations and bundled payment programs are all incentivizing hospitals and health systems to do things that will get the most value out of Medicare dollars - including spending on post-hospital care. For instance, the Hospital Value-Based Purchasing Program is penalizing hospitals that spend more than their peers on "episodes of care" that start just before a patient enters the hospital, and ends 30 days after they leave the hospital.

Source-Eurekalert