The Uncertain Future of Nursing Home Post-Acute Care

Several decades ago, the introduction of the prospective payment system by diagnosis-related groups created a tremendous incentive for hospitals to shorten length of stay. Suddenly, there was a new person rounding with each inpatient team, paid for by hospital administration. These were “discharge planners,” and their job was to get physicians thinking about how to discharge a patient expediently even as they were writing admission orders. Rapidly, US hospitals pivoted to focus on short, procedure-heavy service provision, in contrast to many other countries, in which hospitals continue to offer a more leisurely process of patient evaluation or convalescence, leading to the unsurprising finding that a couple of extra days in the hospital is an effective strategy for minimizing rehospitalization.