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An All-Payer View of Hospital Discharge to Postacute Care

How many hospital patients are discharged to post acute care? According to a new report from the Agency for Healthcare Research and Quality, nearly 8 million hospital inpatients — 22.3% of all hospital discharges in 2013 — required continued post acute care, such as skilled nursing, rehabilitation, home care, or palliative care. Home health agencies accounted for 50% of the discharges to post acute care, while another 40% were for skilled nursing.

Medicare patients had the highest rate of hospital discharges going to post acute care — 41.7%. Total hip/knee replacement was the most common condition/procedure for post acute care [PAC]. Over 70% of all total hip/knee replacement patients went to PAC, and they accounted for nearly 10% of all discharges to PAC.

Hospital stays were nearly twice as long and costly for discharges to post acute care when compared to routine discharges.

Source: Tian W. An all-payer view of hospital discharge to postacute care, 2013. HCUP [Healthcare Cost and Utilization Project] Statistical Brief #205, May 2016. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Role of Post-Acute Care in New Care Delivery Models

With new models for the delivery of health care, post-acute care provides — long-term care hospitals, skilled nursing  and rehabilitation facilities, and home health agencies — have an important role to play. They can help reduce hospital readmissions, improve care coordination and care setting transitions, and participate in the development of bundled payment approaches.

A new Trendwatch report from the American Hospital Association looks at the factors driving changes in post-acute care and highlights innovative examples of how leading post-acute care providers and health systems are adjusting and creating new business models to improve patient care.

A separate addendum report provides more background on Medicare spending by sectors within post-acute care and their patient characteristics. Medicare’s current fee-for-service system by post-acute care venue is also summarized.

Source: Role of post-acute care in new care delivery models. Trendwatch, American Hospital Association, Dec. 2015. http://www.aha.org/research/reports/tw/15dec-tw-postacute.pdf  Addendum: Background On Post-Acute Care. http://www.aha.org/research/reports/tw/15dec-tw-postacute-adden.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Top 50 Home Healthcare Agencies

SK&A has published a ranking of the largest home healthcare agencies in the U.S. based on number of employees. Topping the list of are two New York based agencies:

  1. Visiting Nurse Service of NY with 15,300 employees
  2. Empire State Home Care with 7,000 employees

Also listed are  the top 12 owners of multiple home health agencies the most agencies. Heading this list are:

  1. Visiting Nurse Association [249 agencies]
  2. Apria Health Care [163 agencies
  3. Interim Healthcare [139 agencies]

Aggregate data on the types of services offered by home health agencies is included as well.

Source: Home healthcare agencies. SK&A, Dec. 2015. http://www.skainfo.com/health_care_market_reports/home_healthcare_agencies.pdf [Free registration may be required to view]

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ADVANCE DIRECTIVES: Making choices for the end of life

Over one-quarter of Medicare payments are made for patients in the last year of their lives.  There can be a disconnect between what patients want in terms of medical care and treatment at the end of their lives and what actually happens once 911 is called.  There have been attempts to address this disconnect through development of advance directive documents (which can go missing over time or be misinterpreted).

Here are some resources to help in end of life planning.

Gundersen Health System has implemented an advance directive program  that has resulted in an almost perfect match between a dying patient’s wishes and treatment decisions.  Also, the cost of care during the last two years of life, as well as the intensity of hospital care during this period, is lower than the national average.

Source: Fifer, J.J. (2015, Nov.). Time to break the last taboo. HFM. Healthcare Financial Management, 69(11), 28. Retrieved from http://www.hfma.org/Content.aspx?id=42943

Profile of Adult Day Care Services & Patients

As part of its ongoing National Study of Long-Term Care Providers, the National Center for Health Statistics has recently released its findings on adult day care services. Here are some highlights:

  • There were 4800 adult day services centers in the US in 2012, serving 272,300 participants daily.
  • The proportion of for-profit centers has grown from 27% in 2010 to 40% in 2012.
  • 41% of centers are chain-affiliated.
  • Nearly all centers offered daily transportation for participants, and more than half provided skilled nursing, therapeutic, and social work services.
  • While the majority of day care participants were over age 65, 37% were younger.
  • Nearly a third of participants had Alzheimer’s or other dementias, a quarter had a developmental disability, and another quarter had depression.
  • Just 6% of day care participants made an ER visit in the previous 90 days, while a similar percentage had had a hospital discharge.


Dwyer LL and others. Differences in adult day services center characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 165, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db165.htm

Dwyer LL and others. Differences in adult day services center participant characteristics by center ownership: United States, 2012. NCHS [National Center for Health Statistics] Data Brief, no. 164, Sept. 2014. http://www.cdc.gov/nchs/data/databriefs/db164.htm

2012 National study of long-term care providers: state web tables for adult day services centers component [description]. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/2012_state_web_tables_description.pdf

State estimates for NCHS Data Brief no. 165. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_165.pdf#table1

State estimates for NCHS Data Brief no. 164. National Center for Health Statistics, accessed Sept. 11, 2014 at http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Data_Brief_164.pdf#table1

Related sources:

National Adult Day Services Association (NADSA)

MetLife national study of adult day services, providing support to individuals and their family caregivers. MetLife Mature Market Institute, Oct. 2010. https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-adult-day-services.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org



U.S. Elder Care Market – Top 50 Nursing Homes & Systems

SK&A has just released an update of its report that lists the top 50 nursing homes in the U.S. based on bed size. It also ranks the top 50 nursing home systems based on the number of nursing homes.

Topping the list of the largest nursing homes are:

  1. Laguna Wood Community – Laguna Woods, CA – 12,736 beds
  2. Rossmoor Walnut Creek — Walnut Creek, CA – 10,000 beds
  3. Fair Acres Geriatric Center – Lima, PA – 908 beds

The largest nursing home systems are:

  1. Genesis Healthcare – 326 nursing homes
  2. Golden Living – 305 nursing homes
  3. HCR Manor-Care – 301 nursing homes

The report also ranks the states by the number of nursing homes and lists the number of nursing home beds in each state. The number of nursing homes are classified by ownership type and by type of care provided, such as skilled nursing, assisted living and 10 other categories.

Source: U.S. elder care market. SK&A, June 2014. http://www.skainfo.com/registration.php [Free registration required]

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Long-Term Care Services in the US: 2013 Overview

A new report from the National Center for Health Statistics provides information on the supply, organizational characteristics, staffing, and services offered by long term care service providers, including adult day service centers, residential care communities, home health agencies, hospices, and nursing homes.  It also profiles the users of these services, covering their demographic, health, and functional characteristics.

In 2012 there were about 58,500 regulated long term care service providers in the nation that served 8 million people. These providers included:

  • 4,800 adult day services centers
  • 12,200 home health agencies
  • 3,700 hospices
  • 15,700 nursing homes
  • 22,200 assisted living and similar residential care communities

Geographical differences in the supply, use and characteristics of long term care services are also presented.

Source: Harris-Kojetin L and others. Long-term care services in the United States:  2013 overview. National Center for Health Statistics, Dec. 2013. http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf. Related state web tables and maps: http://www.cdc.gov/nchs/data/nsltcp/State_estimates_for_NCHS_Series_3_37.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org