Postacute Care: Reasons for Its Growth and a Proposal for Its Control Through the Early Detection, Treatment, and Prevention of Hospital-Acquired Disability

Published:August 02, 2014DOI:


      Postacute care costs have doubled over the past decade and now account for 17% of Medicare fee-for-service spending. Costs are forecast to continue to rise, paradoxically in large part in response to federal policies and efforts to control health care costs. This commentary introduces a potential solution to this situation and is divided into 4 parts. The first provides a brief review of the policies fostering this growth. The second assesses how the responses of health care providers, while inherently rational, are destructive to the system. The third identifies hospital-acquired disability as a modifiable driver in this scenario, and the fourth discusses how an improvement in detection and a redistribution of hospital-based rehabilitation services may be able to reverse this unsustainable growth.


      List of abbreviations:

      DRG (diagnosis-related group), PAC (postacute care)
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      1. Medicare Payment Advisory Commission. Medicare post-acute care reforms. 2013. Available at: Accessed April 18, 2014.

        • Newhouse J.P.
        • Garber A.M.
        Geographic variation in Medicare services.
        N Engl J Med. 2013; 368: 1465-1468
        • Chandra A.
        • Dalton M.A.
        • Holmes J.
        Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings.
        Health Aff (Millwood). 2013; 32: 864-872
        • Nelson C.J.
        • West T.
        • Goodman C.
        The hospital built environment: what role might funders of health services research play?.
        Agency for Healthcare Research and Quality, Rockville2005
        • Covinsky K.E.
        • Palmer R.M.
        • Fortinsky R.H.
        • et al.
        Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age.
        J Am Geriatr Soc. 2003; 51: 451-458
        • Pashikanti L.
        • Von Ah D.
        Impact of early mobilization protocol on the medical-surgical inpatient population: an integrated review of literature.
        Clin Nurse Spec. 2012; 26: 87-94
        • de Morton N.A.
        • Keating J.L.
        • Jeffs K.
        The effect of exercise on outcomes for older acute medical inpatients compared with control or alternative treatments: a systematic review of randomized controlled trials.
        Clin Rehabil. 2007; 21: 3-16
        • Stiller K.
        Physiotherapy in intensive care: an updated systematic review.
        Chest. 2013; 144: 825-847
      2. Hospital acute inpatient services payment system. 2009. Available at: Accessed July 14, 2014.

        • Engel H.J.
        • Needham D.M.
        • Morris P.E.
        • Gropper M.A.
        ICU early mobilization: from recommendation to implementation at three medical centers.
        Crit Care Med. 2013; 41: S69-80
        • Hoyer E.H.
        • Needham D.M.
        • Atanelov L.
        • Knox B.
        • Friedman M.
        • Brotman D.J.
        Association of impaired functional status at hospital discharge and subsequent rehospitalization.
        J Hosp Med. 2014; 9: 277-282
      3. Gage B, Constantine R, Aggarwal J, et al. The development and testing of the Continuity Assessment Record and Evaluation (CARE) Item Set: final report on the development of the CARE Item Set. Centers for Medicare & Medicaid Services, Office of Clinical Standards and Quality, 2012. Available at: Accessed July 14, 2014.