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Breaking the chain: how new Medicare changes threaten continuum of care.

Recent actions by the Health Care Financing Administration (HCFA) and the Office of the Inspector General could drive up inpatient lengths of stay, discourage hospital ownership of home health agencies, and make seamless transitions across the continuum of care more difficult than ever, some experts say. As of Oct. 1, HCFA's new transfer payment policy has already taken effect, penalizing hospitals for discharging patients with certain conditions directly to postacute care. Critics contend that the new policy will encourage hospitals to keep these patients in acute care longer and cost the hospital industry approximately $600 million per year. The transfer payment rules also raise thorny issues for discharge planners, who need to make absolutely sure they know what sort of care patients receive once they leave the hospital, experts say.