Did the Medicare Inpatient Rehabilitation Facility Prospective Payment System Result in Changes in Relative Patient Severity and Relative Resource Use?

Paddock, Susan M.; Escarce, José J.; Hayden, Oliver; Buntin, Melinda Beeuwkes

doi:10.1097/01.mlr.0000250863.65686.bc

Cited by 14 publications

(13 citation statements)

References 14 publications

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“…Our estimates of the effects of the IRF-PPS on costs and outcomes might be biased due to changes in patient characteristics (such as changes in functional status) that are coincident with the implementation of the IRF-PPS but not evident in the claims data that we use for our analysis. However, the likelihood of such bias is small given that we find little or no change in observable characteristics of patients and others studies using richer clinical data and measures of functional status find similar results(Paddock et al 2007). However, it is important to note that we compare average patient characteristics before and after the IRF-PPS.…”

Section: Discussionmentioning

confidence: 50%

The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities

Sood

Huckfeldt

Grabowski

et al. 2013

Journal of Health Economics

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We examine provider responses to the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS), which simultaneously reduced marginal reimbursement and increased average reimbursement. IRFs could respond to the PPS by changing the number of patients admitted, admitting different types of patients, or changing the intensity of care. We use Medicare claims data to separately estimate each type of provider response. We also examine changes in patient outcomes and spillover effects on other post-acute care providers. We find that costs of care initially fell following the PPS, which we attribute to changes in treatment decisions rather than the characteristics of patients admitted to IRFs within the diagnostic categories we examine. However, the probability of admission to IRFs increased after the PPS due to the expanded admission policies of providers. We find modest spillover effects in other post-acute settings and negative health impacts for only one of three diagnostic groups studied.

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Section: Discussionmentioning

confidence: 50%

The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities

Sood

Huckfeldt

Grabowski

et al. 2013

Journal of Health Economics

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“…Selection behavior involves changing admission policies limiting access to less profitable patients (i.e., hip fracture patients with cognitive impairment) while increasing access to patients with more profitable conditions (i.e., hip fracture patients with higher functional independence). 58 Upcoding (ie, deliberately coding higher motor function in patients with hip fracture on discharge), might be an attempt to increase revenue; upcoding is more frequently observed in for-profit facilities and those in more competitive markets. 60,61 Because organizational philosophies and managerial practices in for-profit IRFs (vs. other ownership types [non-profit or government owned IRFs]), reflect differences in decisions that influence service delivery, staffing, patients, and ultimately IRF performance, 56,62 the for-profit IRFs in this study might have been more sensitive to such profit-maximizing strategies and could explain, in part, higher motor function on discharge.…”

Section: Discussionmentioning

confidence: 99%

Performance-Based Outcomes of Inpatient Rehabilitation Facilities Treating Hip Fracture Patients in the United States

Cary

Baernholdt

Anderson

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Objective To examine the influence of facility and aggregate patient characteristics of inpatient rehabilitation facilities (IRFs) on performance-based rehabilitation outcomes in a national sample of IRFs treating Medicare beneficiaries with hip fracture. Design Secondary data analysis. Setting U.S. Medicare-certified IRFs (N=983). Participants 983 US Medicare-certified IRFs. Data included 34,364 patient records of Medicare beneficiaries admitted in 2009 for rehabilitation after hip fracture. Main Outcome Measures Performance-based outcomes included mean motor function on discharge, mean motor change (mean motor score on discharge minus mean motor score on admission) and percentage discharged to the community. Results Higher mean motor function on discharge was explained by aggregate characteristics of hip fracture patients (lower age [p=0.009], lower percentage of Blacks [p<0.001] and Hispanics [p<0.001], higher percentage of females [p<0.030], higher motor function on admission [p<0.001], longer length of stay [p<0.001]) and facility characteristics (freestanding [p<0.001], rural [p<0.001], for-profit [p=0.048], and smaller IRFs [p=0.041]). The findings were similar for motor change, but motor change was also associated with lower mean cognitive function on admission (0.008). Higher percentage discharged to the community was associated with aggregate patient characteristics (lower age [p<0.001], lower percentage of Hispanics [p=0.009], higher percentage of patients living with others [p<0.001], and higher motor function on admission [p<0.001]). No facility characteristics were associated with percentage discharged to the community. Conclusion Performance-based measurement offers health policymakers, administrators, clinicians, and consumers a major opportunity for securing health system improvement by benchmarking or comparing their outcomes to other similar facilities. These results might serve as the basis for benchmarking and quality-based reimbursement to IRFs for one impairment group: hip fracture.

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“…For example, a study by Paddock et al 7 looked at changes in a case-mix among patients with stroke, hip fracture, and lower extremity joint replacement. Results suggested that there was no difference in the severity of patients admitted to IRFs pre-versus post-PPS implementation.…”

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confidence: 99%

“…In addition, even without a change in the case-mix, IRFs in most studies have demonstrated a decrease in length of stay. 7–10 However, rather than lead to a decreased need for services, Zorowitz 11 notes that the focus on length of stay has increased discharges to skilled nursing facilities (SNFs) prior to the completion of rehabilitation, as well as increased the number of transfers between facilities during care.…”

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Change in Inpatient Rehabilitation Admissions for Individuals With Traumatic Brain Injury After Implementation of the Medicare Inpatient Rehabilitation Facility Prospective Payment System

Hoffman¹,

Brown²,

Chan³

et al. 2012

Archives of Physical Medicine and Rehabilitation

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Objective To evaluate the impact of Medicare’s inpatient rehabilitation facility (IRF) prospective payment system (PPS) on use of inpatient rehabilitation for individuals with traumatic brain injury (TBI). Design Retrospective cohort study of patients with TBI. Setting One hundred twenty-three level I and II trauma centers across the U.S. who contributed data to the National Trauma Data Bank. Participants Patients (N = 135,842) with TBI and an Abbreviated Injury Score of the head of 2 or greater admitted to trauma centers between 1995 and 2004. Interventions None. Main Outcome Measure Discharge location: IRF, skilled nursing facility, home, and other hospitals. Results Compared with inpatient rehabilitation admissions before IRF PPS came into effect, demographic characteristics of admitted patients changed. Those admitted to acute care trauma centers after PPS was enacted (January 2002) were older and nonwhite. No differences were found in rates of injury between men and women. Over time, there was a significant drop in the percent of patients being discharged to inpatient rehabilitation, which varied by region, but was found across all insurance types. In a logistic regression, after controlling for patient characteristics (age, sex, race), injury characteristics (cause, severity), insurance type, and facility, the odds of being discharged to an IRF after a TBI decreased 16% after Medicare’s IRF PPS system was enacted. Conclusions The enactment of the Medicare PPS appears to be associated with a reduction in the chance that patients receive inpatient rehabilitation treatment after a TBI. The impact of these changes on the cost, quality of care, and patient outcome is unknown and should be addressed in future studies.

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Did the Medicare Inpatient Rehabilitation Facility Prospective Payment System Result in Changes in Relative Patient Severity and Relative Resource Use?

Abstract: IRF patient composition has not changed meaningfully for Medicare beneficiaries, but patients within payment groups are being provided less care, which could be attributable to the IRF PPS, existing trends in decreasing length of stay, or both.

Cited by 14 publications

References 14 publications

The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities

The effect of prospective payment on admission and treatment policy: Evidence from inpatient rehabilitation facilities

Performance-Based Outcomes of Inpatient Rehabilitation Facilities Treating Hip Fracture Patients in the United States

Change in Inpatient Rehabilitation Admissions for Individuals With Traumatic Brain Injury After Implementation of the Medicare Inpatient Rehabilitation Facility Prospective Payment System

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