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Is less more? Rehabilitation for elderly people following hip fracture

June 26, 2018

Following surgery for hip fracture, elderly people undergoing rehabilitation experienced more favorable outcomes when providers were remunerated per patient rather than by the amount of care received, according to the findings of a research article by Vincent Mor of Brown University School of Public Health, United States, and colleagues published in PLOS Medicine.

In the United States, health insurance can be provided to older people via the Medicare Fee-For-Service (FFS) program, where providers are remunerated according to the amount of care provided, or via Medicare Advantage (MA), where selected providers are remunerated according to the number of patients. Mor and colleagues studied data for 211,296 FFS patients and 75,554 MA patients who had been discharged following hip fracture hospitalization to a skilled nursing facility and, after adjustment for differences between the groups of patients, report on the amount of care received and outcomes for patients.

The findings indicate that, compared to FFS patients, MA patients spent approximately 5 fewer days in nursing facilities and received about 12 fewer minutes of rehabilitation therapy per day. Despite this, MA patients had a lower rate of readmission to hospital within 30 days than FFS patients, and a higher rate of successful discharge to the community. The findings could indicate that the additional care delivered to this group of FFS patients was not beneficial, for example, or that MA programs employed more effective discharge processes. The authors conclude that "improving the efficiency and quality of post-acute care by reducing unnecessarily long rehabilitation stays in costly settings and shifting therapy care towards home-based services may be a new norm in value-based care."
Research Article


This study was supported in part by National Institute of Aging grants P01AG027296, R01AG044374-01, R034G050002, and R01AG047180. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: VM is the Chair of the Independent Quality Committee at HCR ManorCare and is compensated for this service; VM is a paid consultant to NaviHealth, Inc. and chair their Scientific Advisory Board; VM is the former Director at PointRight, Inc. While he no longer provides any services or hold any positions at PointRight, he holds less than 1% equity. The other authors have declared that no competing interests exist.


Kumar A, Rahman M, Trivedi AN, Resnik L, Gozalo P, Mor V (2018) Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data. PLoS Med 15(6): e1002592.

Author Affiliations:

Center for Gerontology and Health Care Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island, United States of America Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America

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