Invited commentary| Volume 95, ISSUE 2, P218-221, February 2014

Are We Asking the Right Question About Postacute Settings of Care?

  • Gerben DeJong
    Corresponding author Gerben DeJong, PhD, FACRM, MedStar National Rehabilitation Hospital, 102 Irving St NW, Washington, DC 20010.
    MedStar National Rehabilitation Hospital, Washington, DC; Georgetown University School of Medicine, Washington, DC; and MedStar Health Research Institute, Washington, DC
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Published:November 04, 2013DOI:


      This issue of Archives includes an article by Mallinson et al that compares the outcomes of patients with hip fracture who received rehabilitation services in 3 different postacute settings: skilled nursing facilities, inpatient rehabilitation facilities, or home health. Except in 1 instance, Mallinson found no setting-specific effects and noted that the issue of defining an optimum postacute rehabilitation program is complex and requires more investigation. Mallinson's findings are interesting in their own right but raise a more fundamental issue. This commentary observes that rehabilitation patients typically use multiple postacute settings, not just 1 setting of care, for the same episode of care. This commentary asks whether we should be examining episode outcomes and not just setting-specific outcomes, especially in the face of bundled payment and value-based payment reforms in the Affordable Care Act.


      List of abbreviations:

      BPCI (Bundled Payment for Care Improvement Initiative), CARE (Continuity Assessment Record and Evaluation), CMS (Centers for Medicare and Medicaid Services), DRG (diagnosis-related group), IRF (inpatient rehabilitation facility), LTCH (long-term care hospital), MDS (Minimum Data Set), SNF (skilled nursing facility)
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