title: Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings.
abstract: Identifying policies that will cut or constrain US health care spending and spending growth dominates reform efforts, yet little is known about whether the drivers of spending levels and of spending growth are the same. Policies that produce a one-time reduction in the level of spending, for example by making hospitals more efficient, may do little to reduce subsequent annual spending growth. To identify factors causing health care spending to grow the fastest, we focused on three conditions in the Medicare population: heart attacks, congestive heart failure, and hip fractures. We found that spending on postacute care-long-term hospital care, rehabilitation care, and skilled nursing facility care--was the fastest growing major spending category and accounted for a large portion of spending growth in 1994-2009. During that period average spending for postacute care doubled for patients with hip fractures, more than doubled for those with congestive heart failure, and more than tripled for those with heart attacks. We conclude that policies aimed at controlling acute care spending, such as bundled payments for short-term hospital spending and physician services, are likely to be more effective if they include postacute care, as is currently being tested under Medicare's Bundled Payment for Care Improvement Initiative.
authors: Kennedy School of Government, Harvard University, Cambridge, Massachusetts, USA. amitabh_chandra@harvard.edu
authors: Amitabh
authors: A
authors: Chandra
authors: Maurice A
authors: MA
authors: Dalton
authors: Jonathan
authors: J
authors: Holmes
mesh_terms: D017046:Cost Savings / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy / Q000191:economics; D006333:Heart Failure / Q000191:economics; D006620:Hip Fractures / Q000191:economics; D006801:Humans; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000191:economics; D012866:Skilled Nursing Facilities / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Cost Of Health Care; Health Economics; Health Spending; Medicare
references: N Engl J Med. 2012 Mar 22;366(12):1075-7
references: 22435368
references: JAMA. 2009 Oct 14;302(14):1573-9
references: 19826027
references: Surgery. 2002 Nov;132(5):787-94
references: 12464861
references: J Econ Perspect. 2011 Spring;25(2):27-46
references: 21595324
references: JAMA. 2010 Jun 2;303(21):2141-7
references: 20516414
references: Health Aff (Millwood). 2010 Sep;29(9):1714-24
references: 20651002
references: Perspect Biol Med. 2005 Winter;48(1 Suppl):S42-53
references: 15842086
references: Health Aff (Millwood). 2011 Sep;30(9):1708-17
references: 21900662
references: Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-184-97
references: 15451981
references: Health Aff (Millwood). 2001 Sep-Oct;20(5):11-29
references: 11558696
references: N Engl J Med. 2010 Jul 1;363(1):45-53
references: 20463332
references: JAMA. 1992 Nov 11;268(18):2530-6
references: 1404820
references: JAMA. 2009 Aug 19;302(7):767-73
references: 19690309
references: Health Care Financ Rev. 2004 Summer;25(4):119-41
references: 15493448
references: Health Aff (Millwood). 2011 Nov;30(11):2107-15
references: 22068403
references: Am J Manag Care. 2010 Feb;16(2):131-8
references: 20148618
references: Health Aff (Millwood). 2006 Mar-Apr;25(2):w34-47
references: 16464904
references: Ann Intern Med. 2003 Feb 18;138(4):288-98
references: 12585826
references: N Engl J Med. 2008 Jul 3;359(1):3-5
references: 18596270
references: JAMA. 2011 Mar 16;305(11):1113-8
references: 21406648
references: Med Care. 2005 Feb;43(2):182-8
references: 15655432