The Care Continuum for Hospitalized Medicare Beneficiaries Near Death

Letters15 May 2018The Care Continuum for Hospitalized Medicare Beneficiaries Near DeathDaniel E. Lage, MD, MSc, Daryl J. Caudry, SM, D. Clay Ackerly, MD, MSc, Nancy L. Keating, MD, MPH, and David C. Grabowski, PhDDaniel E. Lage, MD, MScHarvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (D.E.L.), Daryl J. Caudry, SMHarvard Medical School, Boston, Massachusetts (D.J.C., D.C.G.), D. Clay Ackerly, MD, MScVanderbilt University School of Medicine, Nashville, Tennessee (D.C.A.), Nancy L. Keating, MD, MPHHarvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (N.L.K.), and David C. Grabowski, PhDHarvard Medical School, Boston, Massachusetts (D.J.C., D.C.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2651 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Rising use of postacute care (PAC) facilities over the past 2 decades has contributed to increased transitions of care in the last year of life (1, 2). Medicare PAC facility benefits cover rehabilitation from acute illness in skilled nursing facilities, inpatient rehabilitation facilities, or long-term acute care hospitals. Amid pressure to reduce length of stay, hospitals often use PAC facilities as a stopgap and send elderly patients near the end of life to facilities designed more for rehabilitation than palliative care. The role of PAC facilities as a discharge destination for patients in the last days or weeks of ...References1. Wang SY, Aldridge MD, Gross CP, Canavan M, Cherlin E, Bradley E. End-of-life care transition patterns of Medicare beneficiaries. J Am Geriatr Soc. 2017;65:1406-13. [PMID: 28369785] doi:10.1111/jgs.14891 CrossrefMedlineGoogle Scholar2. Aragon K, Covinsky K, Miao Y, Boscardin WJ, Flint L, Smith AK. Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life. Arch Intern Med. 2012;172:1573-9. [PMID: 23026981] doi:10.1001/archinternmed.2012.4451 CrossrefMedlineGoogle Scholar3. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291:88-93. [PMID: 14709580] CrossrefMedlineGoogle Scholar4. Ackerly DC, Grabowski DC. Post-acute care reform—beyond the ACA. N Engl J Med. 2014;370:689-91. [PMID: 24552314] doi:10.1056/NEJMp1315350 CrossrefMedlineGoogle Scholar5. Barr P. In the preferred setting? Reimbursement's role in hospice vs. skilled nursing. Mod Healthc. 2013;43:30-1. [PMID: 23487979] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (D.E.L.)Harvard Medical School, Boston, Massachusetts (D.J.C., D.C.G.)Vanderbilt University School of Medicine, Nashville, Tennessee (D.C.A.)Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (N.L.K.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2651.Reproducible Research Statement: Study protocol: Not available. Statistical code: Available from Dr. Grabowski (e-mail, [email protected]med.harvard.edu). Data set: Available at www.cms.gov/Research-Statistics-Data-and-Systems/Research/ResearchGenInfo/index.html.This article was published at Annals.org on 13 February 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPost-Acute Care Outcomes of Cancer Patients <65 Reveal Disparities in Care Near the End of LifePilot Trial of a Social Work Intervention to Provide Palliative Care for Adults with Cancer in Skilled Nursing FacilitiesForced to Choose: When Medicare Policy Disrupts End-of-Life CarePostacute care outcomes in home health or skilled nursing facilities in patients with a diagnosis of dementiaOutcomes of post‐acute care in skilled nursing facilities in Medicare beneficiaries with and without a diagnosis of dementiaSuccessful Discharge to Community Gap of FFS Medicare Beneficiaries With and Without ADRD NarrowedPotentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancerRehabbed to Death Reframed: In Response to "Rehabbed to Death: Breaking the Cycle"Rehabbed to Death 15 May 2018Volume 168, Issue 10Page: 748-750KeywordsCaregiversDisclosureElderlyEnd of life careForecastingHealth care facilitiesHospitalsInpatientsMedicarePalliative care ePublished: 13 February 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...