'Post-Acute' Costs Exploding

Dec 2, 2013

Per-person Medicare spending, much higher in Florida than all but one other state, has seen a dramatic increase in "post-acute" services -- nursing homes, home-health services, rehabilitation, and so on. And there is no rhyme or reason to the spending; patients who are much alike may be sent to nursing homes in one region, sent home in another. 

As a result, Kaiser Health News reports, researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. And Florida, as usual, is an outlier. Home-health-agency billing has been so high in South Florida -- much of it fraudulent -- that there is a moratorium on allowing new ones to bill Medicare in the Miami area.

To bring spending under control, Medicare is trying to get hospitals and those who provide after-care to work together by giving them a lump sum to take care of a patient.   Other Obama administration proposals would move toward paying the same rates for similar patients.

To see how Florida's spending on Medicare patients compares to that in other states -- leaving aside Medicare Advantage enrollees -- see this chart.

At this federal website, you can read about four types of lump-sum projects called Bundled Payments for Care Improvement.   And on this page, by searching for Florida, you can see which groups have been approved for the project.

Two cities in Florida are sites for bundled payments that cover both hospital and after-hospital care for certain diagnoses.  Memorial Regional Hospital in Hollywood is using the pay system for heart valve and coronary artery bypass patients.

In Jacksonville, St. Vincent Medical Center at Riverside will take bundled payments for patients who have congestive heart failure or undergo joint replacement or spinal fusion. The latter two groups will be under bundled payment at St. Vincent - Southside.