Post‐Acute Care Toolkit: An Introduction to a Comprehensive Guide on Post‐Acute Care Regulations

Abstract

The post-acute care (PAC) model is in the midst of an evolution. With today’s health care environment placing a greater emphasis on value-based purchasing (VBP), payors are examining both the quality and cost of care in PAC. As new payment models are being considered, recognizing the importance of patient oversight within PAC settings is critical. Currently, Medicare defines PAC to include long-term care hospitals (LTCH), skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and home health (HH). However, the type and the amount of rehabilitative therapy services provided between these settings vary greatly across the different levels of care. Regulations around patient eligibility, facility documentation requirements, and quality measurements are critical for physiatrists to understand in order to best choose a PAC setting when discharging a patient from acute care and to ensure optimum patient outcomes. Physicians working in any of these settings, including in the acute care hospital, are often required to advocate for the appropriate level of care for their patients. This typically takes the form of appropriate documentation and peer-to-peer reviews with insurance carriers or other regulatory agents. This understanding and ability to “care manage” a patient through the post-acute environment is critical for today’s physiatrist to provide true value-based care. It needs to be recognized by all stakeholders, not just the treating physiatrist, that some of these levels of care do not have the same standards, so that one size or setting may not fit all. The information provided in this article aims to help you talk to your PAC administrators, fellow physicians, and other caregivers about your and your patients’ needs. The information provided in this article is based on Medicare regulations as Medicare is often the common guide for many payors. An overview of each site’s factors for patient eligibility, facility regulatory requirements, payment (facility and physician), patient measurement tools, and quality reporting is presented. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) plans to update these factors regularly as annual regulations are updated. Please log into aapmr. org when you need an administrative or regulatory question answered about these PAC settings. (Please note, the information provided will cover basic information, as not everyone’s circumstance in their setting may be one size fits all.)