Where Do People Go After Hospital Discharge?

Following a hospitalization, many patients need some form of intensive follow-up care.   As is often the case, Medicare is the primary source of data to study post-acute care, but a new Statistical Brief for the Agency for Healthcare Research & Quality uses an all-payer database to estimate what kind of setting patients receive post-acute care in.   (Stat. Brief)   According to the brief, there were 1,177 inpatient rehabilitation facilities, 422 long-term care hospitals, 15,173 skilled nursing facilities and 12,461 home health agencies in 2014, all of which offer post-acute services.  42% of Medicare patients were discharged to post-acute care in 2013 and spending on this care double from $29 billion in 2001 to $59 billion in 2013.  Clinical guidelines on where to discharge a patient are unclear, so it is largely up to the individual physician or hospital.  On an all-payer basis, in 2013 about 8 million hospital stays were discharged to a post-acute care setting, or 22% of all hospital discharges.   11% went to home health care, 9% to a skilled nursing facility, 1.6% to an inpatient rehabilitation facility and .5% to a long-term care hospital.

Medicare was responsible for 39% of all hospital discharges, private insurance for 31%, Medicaid for 21% and the uninsured were 5%, with 4% being other payers.  Medicare was 73% of discharges to a post-acute setting, private insurance for 16% and Medicaid for 7.5%.  Medicare was the payer for 85% of all hospital discharges to SNFs, 76% of discharges to long-term care hospitals, 69% of discharges to inpatient rehab and 65% to home health agencies.  For private insurance, more than two-thirds of the discharges to post-acute care were to home health agencies.  For Medicaid, most also went to home health.  As would be expected, those hospital stays with the highest cost and/or the longest inpatient stay were most likely to result in a discharge to post-acute care, with the most expensive or longest stays being most likely to have a discharge to a long-term care hospital or an inpatient rehab setting.  Older patients and females were also more likely to have a post-acute care discharge.  There is some geographic variation in discharge patterns.  The most common conditions leading to a post-acute care discharge were hip or knee replacements, sepsis, heart failure, stroke, pneumonia and renal failure.  The top ten conditions accounted for 37% of all post-acute care discharges.  Very useful data, even better when we have a real national all-payer database so we can look at actual claims.