Examining Post Acute Care Relationships in an Integrated Hospital System. 3.2 Post-Acute Care Episodes: First Post-Acute Site of Care, Index Admission Length of Stay and Payment

02/01/2009

This section looks at the use of post-acute services, particularly the first site of care following the hospital discharge but also provides information on the reasons for hospitalization, the length of stay, and the average payments for the stay prior to PAC use.

Over 14.0 percent of beneficiaries had an acute hospital discharge meeting our episode criteria of an acute hospital stay following a 60-day window without acute or PAC service use.12 Of these, 35.2 percent were discharged to a post-acute site of care for further treatment. The largest share of those discharged to PAC were discharged to SNFs (41.1 percent) or home health agencies (37.4 percent) while inpatient rehabilitation hospitals and hospital outpatient therapy providers accounted for 10.3 percent and 9.1 percent, respectively (Table 3-4). Only a small number of beneficiaries with index acute hospital admissions were discharged to LTCHs (2.0 percent). Note that the proportion of beneficiaries discharged to SNF and HHA differed very little from similar analyses conducted using 2005 data (Table 3-5). However, there was a slight decrease in the proportion of beneficiaries discharged to IRF in 2006 compared to 2005 (11.4 percent in 2005 vs. 10.3 percent in 2006) and a corresponding increase in the proportion of beneficiaries discharged to hospital outpatient therapy (8.0 percent in 2005 vs. 9.1 percent in 2006) indicating a shift to increasing use of outpatient therapy services.

Table 3-4. Acute Index Admissions, Mean Length of Stay and Payment, by First Site of PAC, PAC Users 2006

Discharge Destination N % of Acute Discharges
(%)
Mean Length of Stay
(days)
Mean Payment
($)
NOTE: 35.2 percent of live discharges from index acute hospitalizations went on to use PAC in 2006.
SOURCE: RTI analysis of 2006 Medicare Claims 5% sample (MM2Y002).
LTCH 2,235 2.0 16.8 $32,486
IRF 11,240 10.3 6.9 12,725
SNF 44,929 41.1 7.4 9,417
HHA 40,865 37.4 6.1 10,044
Hospital Outpatient Therapy 9,967 9.1 4.8 7,589

 

Table 3-5. Acute Index Admissions, Mean Length of Stay and Payment, by First Site of PAC, PAC Users 2005

Discharge Destination N % of Acute Discharges
(%)
Mean Length of Stay
(days)
Mean Payment
($)
NOTE: 34.8 percent of live discharges from index acute hospitalizations went on to use PAC in 2005.
SOURCE: RTI analysis of 2005 Medicare Claims 5% sample (mmor075b).
LTCH 2,368 2.1 16.4 $30,204
IRF 12,759 11.4 6.7 12,003
SNF 46,129 41.2 7.6 9,085
HHA 41,726 37.3 6.3 9,929
Hospital Outpatient Therapy 8,897 8.0 4.9 7,531
These differences in first site of PAC are also associated with differences in length of stay and payments in the index acute hospital stay. In 2006, beneficiaries discharged to LTCH hospitals had the longest acute hospital length of stay (16.8 days) compared with beneficiaries discharged to outpatient therapy who had the shortest average length of stay of 4.8 days in the acute setting. Payments for the acute settings corresponded to the observed length of stay. Beneficiaries discharged to LTCH hospitals had an average acute hospital payment of $32,486 compared to patients discharged to outpatient therapy for whom acute hospital payments averaged $7,589. These results are as expected and reflect the sicker and more resource intensive populations treated in LTCHs.

Patients discharged to SNFs had an average acute index admission length of stay of 7.4 days compared with 6.9 days for patients discharged to IRFs. Acute hospital payments averaged $9,417 for beneficiaries discharged to SNFs and $12,725 for patients discharged to IRF. The shorter lengths of stay and higher index acute hospital payments for patients discharged to IRFs reflect the patient populations discharged to the IRF setting. These beneficiaries include those receiving surgical procedures for hip and knee replacements or other procedures that lead to higher resource utilization in the acute care setting.

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