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Strategic Patient Discharge: the Case of Long-Term Care Hospitals.

Publication ,  Scholarly Edition
Eliason, PJ; Grieco, PLE; McDevitt, RC; Roberts, JW
November 2018

Medicare's prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient's stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and facilities colocated with other hospitals. Using a dynamic structural model, we evaluate counterfactual payment policies that would provide substantial savings for Medicare.

Duke Scholars

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DOI

Publication Date

November 2018

Start / End Page

3232 / 3265

Related Subject Headings

  • United States
  • Prospective Payment System
  • Patient Discharge
  • Medicare
  • Long-Term Care
  • Length of Stay
  • Insurance, Health, Reimbursement
  • Humans
  • Hospitals, Proprietary
  • Economics, Hospital
 

Citation

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Eliason, P. J., Grieco, P. L. E., McDevitt, R. C., & Roberts, J. W. (2018). Strategic Patient Discharge: the Case of Long-Term Care Hospitals. https://doi.org/10.1257/aer.20170092
Eliason, Paul J., Paul L. E. Grieco, Ryan C. McDevitt, and James W. Roberts. “Strategic Patient Discharge: the Case of Long-Term Care Hospitals.,” November 2018. https://doi.org/10.1257/aer.20170092.
Eliason PJ, Grieco PLE, McDevitt RC, Roberts JW. Strategic Patient Discharge: the Case of Long-Term Care Hospitals. 2018. p. 3232–65.
Eliason, Paul J., et al. Strategic Patient Discharge: the Case of Long-Term Care Hospitals. Nov. 2018, pp. 3232–65. Epmc, doi:10.1257/aer.20170092.
Eliason PJ, Grieco PLE, McDevitt RC, Roberts JW. Strategic Patient Discharge: the Case of Long-Term Care Hospitals. 2018. p. 3232–3265.

DOI

Publication Date

November 2018

Start / End Page

3232 / 3265

Related Subject Headings

  • United States
  • Prospective Payment System
  • Patient Discharge
  • Medicare
  • Long-Term Care
  • Length of Stay
  • Insurance, Health, Reimbursement
  • Humans
  • Hospitals, Proprietary
  • Economics, Hospital