Post-acute care providers offer important restorative and rehabilitation services to Medicare (and private insurer) beneficiaries after an acute care hospital stay. These providers include skilled nursing facilities (SNFs), home health agencies (HHAs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs). Determining which patients should go to what type of PAC facility, for what type of care, and measuring the outcomes and quality of the care in a standard way has been elusive for HHS/CMS (post-acute stakeholders). This situation has been further complicated by the need for Congress / HHS / CMS to reduce Medicare spending. One big casualty of the above is a time-compressed need to measure more and to do it with less. The result has been a blurring of the lines between “measuring” for 1) payment / reimbursement , 2) severity adjusting, and 3) quality improvement.