Post-Acute SNF Care Often Not Cost-Effective

With anything even close to resembling a great stroke association, followup research would occur to create a stroke protocol about when to do hospital release and followup rehabilitation. But since we have fucking failures of stroke associations we will continue to know nothing about what to do. Our stroke medical professionals don't give a shit since the effects of this lack of policy/protocol only affects stroke survivors. There is no blowback to them, no financial penalty for not getting survivors 100% recovered.
 https://www.medpagetoday.com/nursing/Nursing/66956?

Hospitals did better by focusing care on getting patients well enough to go home

• by Christopher Cheney, HealthLeaders Media July 30, 2017

New research on the cost-effectiveness of inpatient care at hospitals compared to skilled nursing facility (SNF) found that hospitals spending intensively on inpatient care and sending patients home rather than to a SNF generated lower one-year mortality rates than hospitals that spend more intensively on post-acute-care at SNFs.
The study used a standard technique for assessing hospital performance, the study's lead author said.
"When you compare hospitals, the big concern is [that] they treat different patients, which makes it very difficult to compare outcomes or how hospitals treat people. But now, we have a new way of comparing very similar patients who go to different hospitals," said Joseph J. Doyle, Jr.
Doyle is a professor of applied economics at the Massachusetts Institute of Technology. He and colleagues at MIT and Vanderbilt University are using Medicare ambulance-service claims data to compare spending and other performance measures at hospitals.
The study Doyle published this month in the Journal of Health Economics, "Uncovering Waste in U.S. Healthcare: Evidence from Ambulance Referral Patterns," examined average 90-day spending on more than 1.5 million Medicare patients.
"We characterized the types of hospitals that get better outcomes. [They] tend to be more intense on the inpatient side. It doesn't necessarily have to be length of stay. Hospitals with better outcomes could be doing more inpatient procedures, for example," Doyle said.
"These hospitals treat patients more intensively during their inpatient stay, then they send people home instead of sending them to SNFs."
More Research Needed
While this finding is provocative, more research is required to draw conclusions on the relative cost-effectiveness of inpatient care versus SNF care, he said. "We are able to characterize the hospitals that get good outcomes, but it's a leap to say we should all mimic the type of care that is given in those hospitals."
"Maybe the hospitals that spend more intensively on inpatient care and send patients home have better doctors and better nurses; it's possible that there are many characteristics of hospitals that result in that type of treatment profile."
In addition to further research to determine whether other hospitals can replicate the mortality outcomes of hospitals with an inpatient-care-intense treatment profile, more research is necessary to examine the cost-effectiveness of SNF care, Doyle said. "This spotlight is suggesting that we should take a close look at post-acute-care."
Comparing the treatment outcomes of patients who are sent home rather than to a SNF after inpatient care is prime area for future research.
"For patients where it is not obvious whether they should go home or go to a SNF, we should have studies that either historically or, even better, prospectively, randomize those patients to either go with home-health care or go to a SNF ... If we send more people home, do we achieve better outcomes or not?"
In addition to the tantalizing findings about inpatient care and SNF care, Doyle's latest research casts doubt about earlier comparative research conducted on hospital performance.
"There is a large literature that suggests it really does not matter what hospital a patient goes to for care, in terms such as survival rates from a heart attack. We are concerned that earlier hospital comparisons did not take into account that the patients were different. We say it does matter where you go," Doyle said.
"If it doesn't matter where you go, then people could say high-intensity hospitals are wasteful."
This report is brought to you by HealthLeaders Media.

• Primary Source

  Journal of Health Economics

  Source Reference: Doyle JJ, et al " Uncovering waste in US healthcare: Evidence from ambulance referral patterns" J Health Econ 2017; DOI: 10.1016/j.jhealeco.2017.03.005.