The missing piece in care coordination: Post-acute care

As hospitals and healthcare systems continue to consolidate, a crucial part of the healthcare continuum remains fragmented: post-acute care.

That's the conclusion of a survey of healthcare executives conducted by NEJM Catalyst.

Only 30 percent of the 375 surveyed said that the post-acute care their patients received upon discharge was mostly coordinated. And a mere 7 percent reported they were fully coordinated. Twenty-four percent say they have formal contractual arrangements with post-acute care providers.

This is borne out in other data. A Nielsen Strategic Health Perspectives and Council of Accountable Physician Practices survey issued earlier this year concluded that only half of all patients receive any sort of care in which providers talk with patients.

The consequences of such lack of care coordination are clear: One of the article's authors recounted the death of her mother-in-law after being transferred to a rehabilitation facility for treatment of a fractured elbow. The rehab facility overlooked the C. diff infection she battled in the hospital and her history of asthma, which contributed to a relapse of the former and her eventual death.

“For many patients, the post-acute setting is a critical part of their care trajectory,” the authors state. “As this market grows, we in healthcare must make sure it does so in a patient-centered manner, without exploding the total cost of care. To move from 7% to 70% of patients receiving fully coordinated care, we must align incentives among primary care, post-acute, and inpatient providers.”

Value-based care is considered one venue to push hospitals to better coordinate the post-discharge services provided to patients. And the NEJM Catalyst article noted that the Medicare Hospital Readmissions Reduction Program is another good vehicle to encourage coordinated care.