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Setting accounted for post-acute care spending variation for THR
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Results showed the type of post-acute care setting for patients who underwent total hip replacement was associated with a wide variation in Medicare spending and that was also the case for coronary artery bypass grafting and colectomy.
“For these three common surgeries, wide variation in post-acute care spending is to a large degree driven by the choice of where a patient goes after they are discharged, whether that be home with health, skilled nursing or inpatient rehab,” Lena M. Chen, MD, MS, assistant professor in the Department of Internal Medicine at the University of Michigan, told Orthopedics Today.
Chen and her colleagues examined post-acute care spending for a 90-day episode of care among fee-for-service Medicare beneficiaries who underwent total hip replacement (THR), coronary artery bypass grafting (CABG) or colectomy between 2009 and 2012. They found a wide variation in spending in post-acute care between hospitals in the lowest spending quintile and hospitals in the highest spending quintile and reported differences of 129% for THR, 103% for CABG and 82% for colectomy.
After adjusting for how intense the post-acute care was, researchers noted the wide variation in spending persisted.
However, after they adjusted for the post-acute care setting — home health care, outpatient rehabilitation, skilled nursing facility or inpatient rehabilitation facility — the results showed spending variation decreased to 16% for THR, 4% for CABG and 21% for colectomy.
“We have known that where a patient goes after being hospitalized matters in terms of the care that a patient receives. Our study looked at how this decision matters in terms of spending, as well,” Chen said.
According to Chen, a next step is to determine how to deliver higher value care for patients.
“We need to figure out what type of post-acute care for which types of patients has the most value,” she said. – by Casey Tingle
- Reference:
- Chen LM, et al. Health Affairs. 2017;doi:10.1377/hlthaff.2016.0668.
- For more information:
- Lena M. Chen, MD, MS, can be reached at University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109; email: lenac@umich.edu.
Disclosure: Chen reports she receives support from the Agency for Healthcare Research and Quality, the NIH and HHS Office of the Assistant Secretary for Planning and Evaluation.