Becker's Hospital Review: Andy Edeburn: The crucial transition period after a major hospital procedure can often mean the difference between full recovery and an adverse event - making post-acute care a critical juncture when it comes to patient outcomes. To put it in perspective, almost half of Medicare patients use some form of post-acute care after an acute discharge. However, there typically has been limited coordination between acute and post-acute providers. Historically, once a patient left the hospital, there was little financial incentive to track patients who required post-acute care. This has driven loose or informal referral relationships between acute and post-acute care providers, as well as limited standards to help clinicians determine the best settings for this type of care.

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