A Study of Stroke Post-Acute Care Costs and Outcomes: Final Report

12/28/2006

This study compared the cost and outcomes of post acute care services after a hospitalization for stroke. After hospitalization, over a third of Medicare beneficiaries use post acute care services, including skilled nursing facilities, inpatient rehabilitation, long-term care hospital, home health care services or outpatient services. We know little about the effectiveness of these settings. Researchers identified the functional status of the person before the stroke, at the beginning of post acute care services, and 90 days after the start of those services. Most patients experienced multiple post acute care settings which added to the overall costs to Medicare.

Patients who went to an inpatient rehabilitation facility and then to a skilled nursing facility had the same outcomes as patients who went directly to a skilled nursing facility, but cost three times as much. Patients using (clinic/hospital based) outpatient therapy received more therapy services and had better outcomes than patients receiving services at home. While home health service had higher total costs and Medicare costs, out-of-pocket costs to beneficiaries were substantially higher for patients using outpatient therapy than home health. This study provided essential information to help reform the post acute care system. [122 PDF pages]

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