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Too many patients choose a post-acute care facility for the wrong reasons because hospitals do not give necessary and needed guidance, according to a paper forthcoming in the Annals of Long-Term Care.

Hospitals commonly “overinterpret” Medicare’s referral regulations and believe they cannot steer patients toward a particular skilled nursing facility for follow-up care, the authors wrote. As a result, patients frequently just go to the facility in the most convenient location, rather than one that is equipped to provide the necessary care. This sets the stage for rehospitalization.

“If I recommend knee surgery to a patient, I provide recommendations on physicians who I know do the procedure well,” stated lead author Arif Nazir, M.D., of the Indiana University Center for Aging Research and IU School of Medicine. “I don’t say, ‘You need surgery, so you should go out and find a doctor who operates on knees close to your or your daughter’s home.’ But that’s really what often happens when patients are about to be discharged from hospitals and need to go to a rehab facility for continued care.”

The paper offers a “roadmap” to help hospitals and patients work together to choose a post-acute setting. It lays out factors to consider, such as disease severity and prognosis, the patient’s insurance and the services offered at the post-acute facility.

The discussion about post-acute care also should begin early in the care episode, so that patients and their families have time to visit facilities, Nazir added.

The complete paper has been published online ahead of print. Nazir’s coauthors are affiliated with the Regenstrief Institute and Saint Louis University School of Medicine.