The Uncertain Future of Nursing Home Post-Acute Care

  • Philip D. Sloane
    Address correspondence to Philip D. Sloane, MD, MPH, Departments of Family Medicine and Internal Medicine, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King, Jr Boulevard, CB 7590, Chapel Hill, NC 27599, USA.
    Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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      Several decades ago, the introduction of the prospective payment system by diagnosis-related groups created a tremendous incentive for hospitals to shorten length of stay. Suddenly, there was a new person rounding with each inpatient team, paid for by hospital administration. These were “discharge planners,” and their job was to get physicians thinking about how to discharge a patient expediently even as they were writing admission orders. Rapidly, US hospitals pivoted to focus on short, procedure-heavy service provision, in contrast to many other countries, in which hospitals continue to offer a more leisurely process of patient evaluation or convalescence, leading to the unsurprising finding that a couple of extra days in the hospital is an effective strategy for minimizing rehospitalization.
      • McGettigan S.
      • Farrell A.
      • Murphy R.
      • et al.
      Improved outcomes with delayed admission to post-acute care: results of a natural experiment.


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      Related Podcast

      February 15, 2022

      February 2022 Issue: Re-Imagining Long-Term Care

      Host: Dr. Karl Steinberg. Featuring Dr. Philip Sloane, Dr. Mallory Brown, Dr. Sheryl Zimmerman. Recorded: February 18, 2022.

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