Skilled Nursing and Readmissions Drive Up Post Hospital Discharge Spending Interview with:
Anup Das

Medical Scientist Training Program
Department of Health Management and Policy
University of Michigan, Ann Arbor

Medical Research: What is the background for this study? What are the main findings?

Response: The Centers for Medicare & Medicaid Services (CMS) recently added a new measure of episode spending to the Hospital Value Based Purchasing program. Participation in this program allows hospitals to receive a financial bonus if they perform well on the included measures. This is the first spending measure in the program, and this change now incentivizes hospitals to improve their quality as well as their spending. The measure evaluates spending from three days before a hospitalization through 30 days post-discharge.

In this study, we find that while high-cost hospitals had higher spending levels in each of the three components of an episode of care (pre-admission, index admission, and post-discharge), differences in post-discharge spending were the main determinants of hospital performance on this measure. High-cost hospitals spent on average $4,691 more than low-cost hospitals in post-discharge care. The majority of post-discharge spending comes from skilled nursing facility or readmission costs. Similarly, hospitals that did worse on this new measure of spending over time did so because of increases in their post-discharge spending.

Medical Research: What should clinicians and patients take away from your report?

Response: Since performance on this spending measure is directly related to whether or not a hospital receives a bonus or a penalty in this CMS program, hospitals that can reduce their post-discharge care spending will increase their likelihood of receiving a bonus. Spending during the index admission as well as pre-admission care did not drive performance on this episode-based measure of spending. Finally, hospitals are being held financially accountable for spending on care that happens both inside and outside of the hospital.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: It will be important to continue to monitor hospital performance on this measure of spending as the Hospital Value-Based Purchasing program evolves. Specifically, how hospitals try to improve their post-discharge care spending will have implications for both performance in this program as well efforts to improve collaborations between hospitals and other settings of care.



Anup Das (2015). Skilled Nursing and Readmissions Drive Up Post Hospital Discharge Spending

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