Chandra co-authored an article appearing in this month's issue of Health Affairs, which found that spending on post-acute care services had spiraled during recent years, making it the main driver of overall Medicare spending growth for treatment for heart attack, heart failure and hip fracture from 1994 to 2009.
According to the article, spending for post-acute care doubled for hip fracture and heart failure patients and more than tripled for heart attack patients during the study period.
Chandra cited a number of factors that contribute to those high costs, including post-acute care's fee-for-service payment structure and the lack of research about how much and which kinds of post-acute services are appropriate.
“It's a perfect storm—we don't have the information we need to know how much care to provide, and we have financial incentives pushing providers to do more,” he said.
In the article, Chandra and his colleagues pushed for new payment models, such as an expanded version of
bundled payments that extends to the post-acute phase. Expanding the scope of bundled payments would encourage hospitals to partner with post-acute providers and provide more efficient care, he argued.
The Innovation Center's focus on post-acute care was welcome news, said James Michel, director of Medicare research and reimbursement for the American Health Care Association, a Washington-based group that represents post-acute and long-term care providers. “We think it's a great opportunity for our members,” he said.
Potential project ideas could cover a wide range of topics, including transitions of care and therapy costs, Michel added. “We are certainly going to push this and help our members if they have an idea they think is worth pursuing.”