title: Post-acute referral patterns for hospitals and implications for bundled payment initiatives.
abstract: BACKGROUND
  Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers.
  
  
  METHODS
  Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used.
  
  
  RESULTS
  The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending.
  
  
  CONCLUSIONS
  The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models.
authors.affiliation: Pardee RAND Graduate School, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Paul Merage School of Business, University of California, Irvine, United States.
authors.forename: Abby
authors.initials: A
authors.lastname: Alpert
authors.affiliation: RAND Corporation, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Huckfeldt
authors.affiliation: RAND Corporation, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Hussey
authors.affiliation: RAND Corporation, United States.
authors.forename: David
authors.initials: D
authors.lastname: Auerbach
authors.affiliation: RAND Corporation, United States.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, United States; Titus Family Department of Clinical Pharmacy, Pharmaceutical Economics & Policy, University of Southern California, United States.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
authors.affiliation: Harvard Medical School, 180 Longwood Avenue, Boston, MA02115, United States. Electronic address: mehrotra@hcp.med.harvard.edu.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
keywords: Bundled payment; Post-acute care; Referral network