Examining Post Acute Care Relationships in an Integrated Hospital System. 3.1.3 Organizational Relationships in Post-Acute Episodes

02/01/2009

The next set of tables examines differences in the proportion of episodes that are discharged to freestanding, subprovider, or colocated PAC services and how these patterns differed from 2005 to 2006 (Table 3-3). These numbers reflect the supply of each type of provider nationally. For example, LTCHs are primarily freestanding hospitals. In 2005, 20.4 percent of acute discharges to LTCHs nationally were to colocated LTCHs, which include LTCHs within 250 yards of the acute provider (Gage, Morley, Constantine, et al., 2008). However, this proportion did decrease to 16.3 percent in 2006. A potential explanation for this decrease may be related to CMS' new policy in FY 2005 limiting the proportion of total LTCH admissions from collocated acute hospitals. This policy, known as the 25 Percent Threshold Rule, limited the number of LTCH admissions from colocated acute hospitals to 25.0 percent of an LTCH's total admissions. Across the other types of PAC providers (IRF, SNF, and HHA), there were only very slight changes in the proportion of beneficiaries discharged to each type of provider between 2005 and 2006.

Although we observed that the total number of freestanding IRFs in the United States is relatively small, the volume of discharges to freestanding IRF providers was approaching half of all beneficiaries admitted to IRFs following discharge from the acute hospital. This is due to the fact that freestanding IRFs are generally much larger than rehabilitation units within acute hospitals. The majority of discharges to SNFs and HHAs are to freestanding providers. The proportion of discharges to providers that are colocated, but do not have a formal subprovider relationship is very small for IRFs, SNFs, and HHAs (all less than 3.0 percent).

Table 3-3. Proportion of Discharges to each First PAC Setting, by Organizational Relationship, 2005 and 2006

2005
First PAC Setting N % Discharges
Discharges to Freestanding Provider Discharges to Hospital-Based Subprovider Discharges to Colocated Provider
LTCH 2,368 79.6 - 20.4
IRF 12,759 49.3 47.8 2.9
SNF 46,129 83.8 13.5 2.7
HHA 41,726 76.9 21.9 1.2
2006
First PAC Setting N % Discharges
Discharges to Freestanding Provider Discharges to Hospital-Based Subprovider Discharges to Colocated Provider
SOURCE: RTI analysis of 2006 Medicare Claims 5% sample (MM2Y002).
LTCH 2,235 83.7 - 16.3
IRF 11,240 47.3 50.2 2.5
SNF 44,929 84.4 12.7 2.9
HHA 40,865 78.0 20.8 1.2

View full report

Preview
Download

"report.pdf" (pdf, 1.14Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®