For frail older adults, an inpatient hospital stay can be destabilizing, often marking the beginning of a decline in functioning. For these folks and their families, the post-hospital period is a risky, confusing, and stressful time. Our Medicare system offers hospital patients a range of different types of “post-acute” care providers to support and rehabilitate patients as they make the journey home. The problem for patients and family caregivers is that not only are there different types of providers in nearly every market, (skilled nursing, rehab hospitals, and home health agencies), but also that there are dozens within each type; and no clear and objective way for consumers or their medical providers to determine the best options. The comparative tools for selecting providers often lack the information that matters most to patients and their families. Further, the quality measures available to judge post-acute care provider quality and performance are severely limited – making it difficult for the hospitals and health plans to use them to help discern differences in value. Need evidence of this? Medicare data shows that in many markets, hospitals continue to spread their discharges over dozens of different post-acute providers – reflecting the mindset that there are few distinctions among providers, that home health and skilled nursing facility care are commodity services they use to discharge patients sicker and faster. Remember the predictions at the inception of value-based care? That hospitals will narrow post-acute networks to the providers with differentiated, high quality services? Well, that hasn’t happened in any significant way.
Treating post-acute care like a commodity leads to three problems:
- The Medicare program overpays for this care.
- Our healthcare system fails our highest cost, most complex patients and their families at a particularly vulnerable time in a care episode, leading to higher overall care costs throughout the rest of their lifetime.
- Investment in quality is not rewarded by the market, making future investment less likely.