title: Are we asking the right question about postacute settings of care?
abstract: This issue of Archives includes an article by Mallinson et al that compares the outcomes of patients with hip fracture who received rehabilitation services in 3 different postacute settings: skilled nursing facilities, inpatient rehabilitation facilities, or home health. Except in 1 instance, Mallinson found no setting-specific effects and noted that the issue of defining an optimum postacute rehabilitation program is complex and requires more investigation. Mallinson's findings are interesting in their own right but raise a more fundamental issue. This commentary observes that rehabilitation patients typically use multiple postacute settings, not just 1 setting of care, for the same episode of care. This commentary asks whether we should be examining episode outcomes and not just setting-specific outcomes, especially in the face of bundled payment and value-based payment reforms in the Affordable Care Act.
authors.affiliation: MedStar National Rehabilitation Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC; and MedStar Health Research Institute, Washington, DC. Electronic address: Gerben.DeJong@MedStar.net.
authors.forename: Gerben
authors.initials: G
authors.lastname: Dejong
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D064650:Home Health Nursing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010351:Patient Discharge; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*
keywords: BPCI; Bundled Payment for Care Improvement Initiative; CARE; CMS; Centers for Medicare and Medicaid Services; Continuity Assessment Record and Evaluation; DRG; IRF; LTCH; MDS; Minimum Data Set; Recovery of function; Rehabilitation; SNF; Skilled nursing facilities; Treatment outcome; diagnosis-related group; inpatient rehabilitation facility; long-term care hospital; skilled nursing facility