Postacute care: reasons for its growth and a proposal for its control through the early detection, treatment, and prevention of hospital-acquired disability.

Abstract

Postacute care costs have doubled over the past decade and now account for 17% of Medicare fee-for-service spending. Costs are forecast to continue to rise, paradoxically in large part in response to federal policies and efforts to control health care costs. This commentary introduces a potential solution to this situation and is divided into 4 parts. The first provides a brief review of the policies fostering this growth. The second assesses how the responses of health care providers, while inherently rational, are destructive to the system. The third identifies hospital-acquired disability as a modifiable driver in this scenario, and the fourth discusses how an improvement in detection and a redistribution of hospital-based rehabilitation services may be able to reverse this unsustainable growth.