Lack of data causes doctors to steer patients to unnecessary post-acute care, experts say

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Without solid research about how discharged hospital patients fare in various post-acute settings, cautious doctors are ordering more intensive and expensive care than is needed, according to medical experts writing in the Harvard Business Review.
 
Providers, payers and the government should support “comparative effectiveness research” to address this issue, wrote the authors. Two of them — Clay Ackerly II, M.D., and Timothy G. Ferris, M.D. — work on post-acute care improvement for Partners HealthCare in Boston, a Pioneer accountable care organization. Co-author Christopher Chen is a fourth-year medical student at Washington University in St. Louis.
 
In addition to increased research, greater investment is needed to establish meaningful quality measures to evaluate the performance of skilled nursing facilities, the column argues. Without “evidence-based guidelines” about where patients are most likely to thrive, “well-meaning, risk-averse” doctors will continue to guide patients to unnecessarily intensive post-acute settings, they state.
 
The column also makes the case for revamping the way Medicare reimburses for skilled nursing care. Replacing the per-diem system with a case-based system would create better incentives for providers, who currently are penalized for discharging residents sooner rather than later, they say.
 
“Based on statistical modeling, we project that a case-based prospective-payment system could be rolled out across fee-for-service Medicare without disrupting provider revenue cycles, would facilitate improvements in patient outcomes, and could save Medicare over $4 billion annually,” they wrote.
 
The HBR column is based on testimony prepared for a Senate Finance Committee hearing on Medicare post-acute issues. The hearing, originally scheduled for Oct. 8, has been postponed indefinitely.
 
Click here to access the complete written testimony.
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