2004S-0170 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 1013: Suggest Priority Topics for Research
FDA Comment Number : EC24
Submitter : Dr. Trudy Mallinson Date & Time: 05/11/2004 06:05:19
Organization : Rehabilitation Institute of Chicago
Category :
Issue Areas/Comments
Under Medicare, post-acute care (PAC) is fragmented, and the potential exists for substitution of services among the various PAC settings.1 Each PAC PPS creates incentives for providers to redirect high cost patients to different sources of PAC care, or to multiple, consecutive PAC settings, suggesting a significant effect of prospective payment system (PPS) implementation in one setting on the delivery of services and patient outcomes in the alternative PAC settings.2 In the absence of clear clinical guidelines about which patients are most appropriately cared for in which setting, concern has been raised that differing reimbursements may have made it advantageous for providers to admit and/or transfer patients within the PAC settings of their own organization, regardless of patient need.3 Almost nothing is known about patterns of PAC use across settings, the costs associated with particular patterns, or how providers have altered patterns of PAC use in response to changing financial incentives. Patients? admission status, therapy service provision, and length of stay can have important consequences for patient function, return to the community, re- hospitalization, admission to subsequent PAC settings, and use of additional medical services following PAC discharge, yet little scientific evidence exists about which PAC settings are most appropriate and most effective for which patients. Addressing access, effectiveness and outcomes of post-acute care should be clear priorities for future research.

1) Gage B., Impact of the BBA on post-acute utilization. Health Care Financing Review, 1999. 20(4): p. 103-126.
2) MedPAC. Report to the Congress. Variation and Innovation in Medicare. 2003: Washington, DC.
3) MedPAC. Report to the Congress: Medicare Payment Policy. March 2001: Washington, DC.