Institutional Postacute Care Use May Help Reduce Readmissions for Ischemic Stroke Patients

Area of Science:

• Health Services Research
• Stroke Rehabilitation
• Medicare Policy

Background:

• Stroke readmissions are common and costly for Medicare patients.
• Institutional postacute care (PAC) is crucial for stroke recovery.
• Medicare payment reforms emphasize care coordination.

Purpose of the Study:

• To determine the causal impact of institutional PAC use on 30-day readmission rates for Medicare ischemic stroke patients.
• To analyze the relationship between PAC utilization and healthcare costs.
• To inform Medicare payment policies regarding stroke care.

Main Methods:

• Utilized instrumental variable (IV) analysis to address endogeneity bias.
• Employed Medicare Provider Analysis and Review (MEDPAR) data from 2010-2016.
• Instrumental variables included patient residence distance to PAC and county-level PAC provider density.

Main Results:

• Naive analysis showed a non-significant increase in readmissions with higher PAC use.
• IV analysis revealed a significant decrease in 30-day readmissions (0.19 percentage points) with increased institutional PAC use.
• Findings suggest that reducing PAC may lead to adverse post-discharge outcomes.

Conclusions:

• Institutional PAC use is associated with reduced 30-day readmissions for ischemic stroke patients.
• Payment incentives aimed at reducing PAC use should consider potential negative impacts on patient outcomes.
• Care coordination and appropriate PAC utilization are vital for optimizing stroke recovery and reducing healthcare expenditures.