Hospitals have saved money in alternative payment models through reducing institutional post-acute care, especially in skilled nursing, but are potentially headed toward unintended negative consequences, experts said last week.

In their zeal to keep their coffers healthy, hospitals may begin to send home patients who need institutional rehabilitation, researchers based at Harvard University said in the New England Journal of Medicine.

Generating savings for Medicare is overall positive, noted David Grabowski, Ph.D. But he warned healthcare systems will find it increasingly difficult to “discriminate between low value and high value” services. 

“As we go further and push down on post-acute care are we no longer eliminating low value?” he told McKnight’s on Friday. He gave an example of an elderly Medicare beneficiary with pneumonia, for which a discharge with home health added on could save thousands of dollars when compared to the option of a skilled nursing facility stay. But other cases, such as a pneumonia case where the patient has co-morbidities, could end with a hospital readmission, and a SNF stay would have been a better choice, both clinically and economically.

Additionally, the Patient-Driven Payment Model will change “dramatically the incentives and admitting those medically complex patients,” Grabowski added.

Another big concern is whether families will increasingly be asked to take care of elderly loved ones who are receiving home care, and whether nursing facilities will increasingly struggle to accept Medicaid patients.

“Providers need to educate us about their bottom line,” said Grabowski, who is also a Medicare Payment Advisory Commission member. “We’re seeing closures in rural areas. Without those post-acute dollars, does it put additional pressure on?”

Ultimately, “you still need outside entities to direct patients to the most efficient and appropriate setting,” he added.