Post-Acute Preparedness in a COVID-19 World

A Framework for Post-Acute Care Recovery and Redesign


The supply of care provided after a hospital stay – commonly referred to as “post-acute care” – has also been disrupted by the pandemic. Under normal conditions, post-acute care providers relieve capacity and reduce costs in inpatient hospital settings by serving a little less than half of all Medicare patients that hospitals discharge. Their normal roles are defined and somewhat constrained by regulatory requirements, clinical capabilities, and other legacy issues.

The role these providers will play now, at a time when hospital capacity is most constrained, is in tremendous flux. On the one hand, Congress and the Centers for Medicare & Medicaid Services (CMS) have invoked emergency authority through legislation and waivers to offer significant new flexibilities to reduce constraints on the types of patients these providers may serve and when they can provide care. On the other hand, the potential for COVID-19 infection of buildings and post-acute care workers (whose access to PPE is much lower than in hospital settings) poses new and significant public health threats that hamper their ability to help solve hospital capacity constraints.

States and local healthcare delivery systems are responding in widely varying ways, ranging from prohibiting transfer of any patients to post-acute settings – without confirmation through testing that patients are not positive for COVID-19 – to mandating that post-acute providers accept such patients to relieve hospital capacity issues. The extreme inconsistencies suggest that we need to approach these non-hospital resources systemically and from a public health perspective.


With proper planning and coordination, post-acute care providers can help achieve several important goals in both the short and long term:

  1. Serve as a hospital relief valve for non-COVID patients, freeing up desperately needed capacity to manage the surge in COVID-positive patients;
  2. Help to prevent hospitalization of non-COVID patients;
  3. Protect current post-acute patients and workers from contracting the virus; and
  4. In targeted cases, operate exclusively as designated post-acute COVID centers.

To achieve these goals, ATI advisory along with post-acute experts William Altman, Howard Gleckman, and David Grabowski, PhD, suggest a four-stage, regionally oriented approach to achieving optimal, system-wide resource allocation across a region’s post-acute service settings and providers over time. This framework is available to support federal, state, and corporate planning.


Any plan’s effectiveness will depend on leadership and implementation of strategies and tactics we outline below at the local and regional level.

Congress and CMS have a responsibility to continuously monitor the effectiveness of regulatory waivers and to adjust post-acute care payment systems to account appropriately for costs associated with treating COVID-19 patients.

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