Abstract
The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a quality measure of successful community discharge for postacute care services. Examining variation in performance nationally can help identify opportunities for improving patient-centered quality of care. To examine US facility-level and geographic variation in rates of successful community discharges after inpatient rehabilitation. This retrospective cohort study of Medicare claims data from December 31, 2013, through October 1, 2015, included 1154 inpatient rehabilitation facilities submitting claims to the Centers for Medicare & Medicaid Services and a total of 487 862 Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities. Analyses were performed from December 8, 2017, through September 11, 2018. Successful community discharge as defined for the Discharge to Community-Post-Acute Care Inpatient Rehabilitation Facility Quality Reporting Program measure. To be considered a successful community discharge, patients had to discharge from the inpatient rehabilitation facility to the community (ie, home or self-care) and remain there without experiencing an unplanned rehospitalization or dying within the following 31 days. Centers for Medicare & Medicaid Services specifications were followed to identify the cohort, define the outcome, and calculate risk-standardized facility and state rates. Among the 487 862 patients included in the cohort, mean (SD) age was 76.4 (10.8) years, and 56.9% were female. The overall rate of successful community discharge after inpatient rehabilitation was 63.7% (95% CI, 63.6%-63.8%). Risk-standardized rates ranged from 42.9% to 83.6% across inpatient rehabilitation facilities. Two hundred sixteen facilities (18.7%) performed significantly better than the mean national rate and 203 (17.6%) performed significantly worse (P < .05). Risk-standardized state rates ranged from 55.9% to 73.3%. Rates were lowest in the Northeast (Massachusetts, 55.9%; New Hampshire, 57.0%) and highest in the West (Oregon, 70.3%; Hawaii, 73.3%). The observed variation suggests opportunities exist for improving this important, patient-centered national quality measure. Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge. These findings can be used to guide care improvement efforts and further improve the consistency and quality of postacute care.
Highlights
The introduction of value-based payment has resulted in profound changes in the delivery of health care in the United States,[1] including the development of quality reporting programs and patientcentered quality measures.[2]
The overall rate of successful community discharge after inpatient rehabilitation was 63.7%
Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge
Summary
The introduction of value-based payment has resulted in profound changes in the delivery of health care in the United States,[1] including the development of quality reporting programs and patientcentered quality measures.[2]. Postacute care has been the focus of recent value-based payment initiatives for several reasons. A report by the National Academy of Sciences found that postacute care services are responsible for the largest geographic variation in Medicare costs when compared with acute care and outpatient services.[5]. Postacute care services represent an important opportunity to improve quality and reduce costs.[5,6]. Substantial research has been conducted examining the role of facility characteristics and geographic location on variation in patient outcomes and health care costs.[7-9]. Most of this research has focused on acute care hospitals and outpatient services. Less research has focused on postacute care, in particular for inpatient rehabilitation facilities
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