Medicare Post-Acute Care: Quality Measurement Final Report. D. What is Known about Post-Acute Care Access and Outcomes?


There is little extant research comparing the care provided by the three types of post-acute providers, patient characteristics associated with receipt of post-acute care in one setting versus another, patient outcomes as they relate to each post-acute setting, or appropriateness of admission of patients to the various post-acute settings. Several studies have compared outcomes of patients with specific diseases treated in different post-acute settings,15;16;17;18 and of a cohort of general medical and surgical patients,19 but there is great need for additional research in this area. In addition, the few extant studies of post-acute care outcomes were conducted before recent changes in payment policy.

Monitoring access to and quality of post-acute care is particularly important, given the reductions in payment and changes to payment policy implemented as a result of the BBA and subsequent legislation. However, each post-acute care setting has its own patient assessment instrument administered at different points during a post-acute care episode. Collecting data at different points in time makes it difficult to compare patient characteristics and outcomes across post-acute settings. In addition, there are significant differences in the data elements contained in existing federally required or proposed patient assessment instruments. For example, in an analysis of the comparability of the MDS, OASIS, MDS-PAC, and FIMs, it was concluded that there “are many differences in the conceptualization of [activities of daily living] and disability terms and definitions.”20 Further, during the September 2000 meeting, MedPAC staff presented preliminary findings from a study that questioned the utility of current administrative data (including patient assessment data) for measuring access to quality health care.21