Post-Discharge Efficiency Incentives May Come with Consequences

Cheryl Clark, for HealthLeaders Media , September 19, 2013

But how, beyond preventing readmissions and improving discharge planning, can hospitals control which pre- and post-discharge services are delivered? And might there be some serious unintended consequences down the line, which instead of lowering costs actually accomplish the opposite?

Ashish  Jha

>Ashish Jha, MD, hospitalist and Harvard health policy expert

Ashish Jha, MD, a hospitalist and Harvard health policy expert, tells me I'm asking important questions that he's been wrestling with too.

"From a patient perspective," he says, "I get why Medicare is doing this; I like the concept because there's a lot to be said for it. But it also has substantial perils, and that part makes me worry. You have to do this thoughtfully, and I don't know [that] we have all the pieces in place now to do it as well as we could."

That's because down the line, Jha says, this could spell trouble for patients not covered by Medicare. Because in trying to incentivize coordination and integration of care outside acute care settings, the policy is in effect incentivizing provider consolidation.

"Now hospitals are buying up other hospitals and physician practices and building relationships with all types of post-acute care services from home health agencies to skilled nursing facilities," he says.

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