Skyrocketing spending on post-acute care shows need for large bundled payment groups, researchers argue

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Post-acute care was the fastest growing major healthcare spending category for government programs between 1994-2009, according to recently released research. The results support large-scale bundled payments as a way to control costs in the future, argued Harvard University's Amitabh Chandra, Ph.D., and his co-authors.

The researchers looked at Medicare per-patient spending associated with three conditions: heart attacks, congestive heart failure and hip fractures. In the post-acute environment, spending more than tripled for heart attack patients, more than doubled for heart failure, and doubled for hip fractures. Among all post-acute settings, skilled nursing facilities saw spending increase the most and at the fastest rate, the researchers found.

The findings suggest that post-acute care providers must be important players in any initiatives to reform the healthcare delivery and payment systems, according to the researchers.

“It remains to be seen whether separate bundling schemes for acute and post-acute care would perform better than large bundles that included both,” Chandra stated. “However, we expect that the latter would produce greater efficiency gains by aligning the incentives of providers, and by allowing them flexibility to choose where patients received care at acute or post-acute care facilities.”

The article appears in the May issue of Health Affairs.