Care after surgery drives costs

Editor's Note

This study finds that where surgical patients go after they are discharged varies widely, and that variation leads to huge differences in how much their care costs.

Variation in postacute care spending between lowest and highest quintiles differed 129% for total hip replacement, 103% for coronary artery bypass grafting (CABG), and 82% for colectomy.

The variation diminished considerably after adjusting for the postacute care setting with a decrease of 16% for hip replacement, 4% for CABG, and 21% for colectomy.

In the end, a hospital’s decision to send patients to an inpatient rehabilitation facility was the key driver of post-hospital costs. To a lesser extent, sending patients to skilled nursing facilities also drove costs, compared with in-home care or outpatient rehabilitiation.

Hospitals seeking to improve accountable care and bundled-payment efficiency should collaborate with patients to choose the highest-value postacute care setting, the authors say.

1Lena M. Chen (lenac{at}umich.edu ) is an assistant professor in the Department of Internal Medicine and at the Institute for Healthcare Policy and Innovation, University of Michigan Health System, and the Center for Healthcare Outcomes and Policy (CHOP), University of Michigan. 2Edward C.