Measuring Value in Post-Acute Care

Publication date: Available online 8 December 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): John F. Butzer, Allan J. Kozlowski, Roberta Virva

Abstract

The value of post-acute care is unclear. While experienced clinicians understand the appropriateness of each specific site of post-acute care, clear evidence-based guidelines are not available, and many referrals to post-acute care today are made based on bed availability rather than patient need. Measuring value (value = outcomes / cost) for the entire episode of care has been proposed as an effective method to both evaluate and enable faster innovation in care. Instituting value-based care will increase patient engagement, improve quality and reduce cost with the potential of unifying the goals for all stakeholders—patients/families, providers, and payers. To achieve a goal of value-based care, rehabilitation researchers will need to measure outcomes and cost for the entire episode of care. Recent laudatory CMS efforts to standardize data across post-acute care may not include the entire episode of care since outpatient care and measurement from home are not included. In addition, the true cost of services delivered is rarely measured. To implement value-based care in rehabilitation and facilitate cost-effective care improvements, outcomes research in post-acute care should focus on four areas. First, outcome measures need to reflect the patient's perspective. Second, new methods must be implemented to acquire comparable valid and reliable data from all post-acute settings and the home. Third, a predictive model for individual patients should be utilized to guide patient referral from acute care to post-acute care and monitor progress. And fourth, timely specific measures of true cost (resources consumed) for the outcomes achieved are needed.

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