title: Postacute care: reasons for its growth and a proposal for its control through the early detection, treatment, and prevention of hospital-acquired disability.
abstract: Postacute care costs have doubled over the past decade and now account for 17% of Medicare fee-for-service spending. Costs are forecast to continue to rise, paradoxically in large part in response to federal policies and efforts to control health care costs. This commentary introduces a potential solution to this situation and is divided into 4 parts. The first provides a brief review of the policies fostering this growth. The second assesses how the responses of health care providers, while inherently rational, are destructive to the system. The third identifies hospital-acquired disability as a modifiable driver in this scenario, and the fourth discusses how an improvement in detection and a redistribution of hospital-based rehabilitation services may be able to reverse this unsustainable growth.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN. Electronic address: Cheville.andrea@mayo.edu.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Cheville
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Basford
mesh_terms: D000359:Aftercare / Q000191:economics / Q000706:statistics & numerical data*; D003289:Convalescence; D003953:Diagnosis-Related Groups; D042241:Early Diagnosis; D017048:Health Care Costs / Q000639:trends; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000639:trends; D051346:Mobility Limitation; D016134:Organizational Policy; D064797:Physical Conditioning, Human / Q000639:trends*
keywords: Function; Healthcare utilization; Policy; Post acute care; Rehabilitation; Reimbursement