Facilities Grab Increased Share of Hospital Discharges

Despite concerns about the rise of home health in the era of value-based care, institutional post-acute care (PAC) use among Medicare beneficiaries actually rose between 2000 and 2015 — while discharges to the home fell over the same time period, according to a research letter published in JAMA.

Specifically, the adjusted percentage of nearly 138 million hospital discharges to PAC rose from 21% in 2000 to 26.3% in 2015, an increase of 5.36 percentage points. The adjusted percentage of discharges home, on the other hand, dropped from 79% in 2000 to 73.6% in 2015.

The length of stay in PAC also increased, rising from 21.7 days in 2000 to 25.7 days in 2014. In 2015, however, it fell to 25.1 days.


The increase in PAC utilization wasn’t surprising, Rachel Werner of the University of Pennsylvania told SNN. But it raises questions about the value of an extra day of SNF therapy, particularly since SNFs are currently paid per diem by Medicare.

“When we pay providers at a per diem rate, it doesn’t give the providers much incentive to send people home or stop delivering care,” Werner said.

Werner and R. Tamara Konetzka of the University of Chicago identified Medicare beneficiaries discharged from an acute care hospital between January 2000 and December 2015 use. They excluded discharges who went to hospice, were below age 65, enrolled in Medicare Advantage (MA), or were discharged to institutional settings other than a skilled nursing facility or inpatient rehabilitation facility (IRF).


The exclusion of those enrolled in MA was noted as a limitation of the study; MA plans are growing in popularity, and Werner noted that MA more actively manages PAC use. She declined to speculate on what the findings might have been if MA had been included, but said the future will likely depend on payment reform. In the research letter, she and Konetzka noted that policy incentives may need to align SNF payment with the goal of reducing SNF use, if they are to effectively decrease length of stay.

“I think there’s still a strong interest in constraining the global budget for health care, and the institutional use of post-acute care in particular is expensive,” Werner said. “So demonstrating its value is going to be really important.”

Written by Maggie Flynn

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