The effect of prospective payment on rehabilitative care

Dobrez, Deborah G.; Sasso, Anthony T. Lo; Heinemann, Allen W.

doi:10.1016/j.apmr.2004.06.064

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…Under PPS, SNF patients may be receiving less rehabilitation therapy, 16 and IRF patients may have shorter stays. 17 The current study results may be used as a reference for patient outcomes before the implementation of major Medicare postacute care policy changes.…”

Section: Discussionmentioning

confidence: 99%

Poststroke Rehabilitation

Deutsch

Granger

Heinemann

et al. 2006

Stroke

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107

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Background and Purpose-To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. Methods-Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. Results-IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]ϭ2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AORϭ1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AORϭ1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AORϭ1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. Conclusions-For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

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Section: Discussionmentioning

confidence: 99%

Poststroke Rehabilitation

Deutsch

Granger

Heinemann

et al. 2006

Stroke

Self Cite

107

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“…Reimbursements for PAC rehabilitation services had increased rapidly following the 1984 introduction of prospective payment for acute care hospitals and ensuing reductions in inpatient lengths of stay (LOSs). 1 From 1989 to 1996, Medicare home health agency spending rose from $2.8 to $11.3 billion, and average numbers of annual home health care visits per Medicare patient increased from 27 to 72. 2 With escalating costs and concerns about widespread variability in utilization patterns, 3 Congress aimed to control the growth in rehabilitation services provided by home health agencies, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.…”

Section: Introductionmentioning

confidence: 99%

“…For IRFs, prospective payments are based on a classification into a case-mix group based on the patient's diagnosis, functional level (measured using the FIM instrument) and age. 1 Some adjustments are also made based on patient factors (eg, comorbidities) and institutional factors (eg, urban vs rural settings). In home health agencies, all agencies are required to use a 60-day episode rate as the basic unit of payment with adjustments allowed.…”

Section: Introductionmentioning

confidence: 99%

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

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Objective-To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design-Data from the nationally representative Medicare Current Beneficiary Survey (MCBS)were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings-Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants-Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions-Not applicable.Main Outcome Measures-Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results-Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This article uses a nationally representative database to analyze the use of 2 PAC servicesphysical (PT) and occupational therapy (OT)-by Medicare beneficiaries with five common diagnoses across various settings of care before and after the 1997 BBA. Looking simultaneously at service use across different rehabilitation settings is important because changes in 1 sector could alter care patterns in another setting. Additionally, exploring changes in service use is complicated by differing timeframes for implementing BBAmandated prospective payment across PAC settings (fig 1). For instance, the BBA created an interim payment system for home health agencies, which was phased in over 12 months beginning October 1, 1997, and controlled both average spending per visit and per Medicare beneficiary; full home health agency prospective payment was implemented in October 2000. A prospective payment system (PPS) was implemented for SNFs in July 1998, and in January 2002 for IRFs. For outpatient therapy, the BBA imposed 2 annual $1500 caps-one for PT...

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“…Possible reasons for the increase in cost associated with psychiatric illness include lowered tolerance for aversive post-TBI symptoms such as headache and fatigue (Fann et al, 1995), and cognitive impairment impacting symptom tolerance and problem-solving (Slomine et al, 2002). This information adds to concern that the costs of providing treatment (e.g., inpatient rehabilitation services) are often greater than reimbursement from Medicare's prospective payment system (Dobrez et al, 2004), and are increased when psychiatric illness such as depression is comorbid (Dobrez et al, 2010). Few studies have examined the effectiveness or costs of depression treatment in the setting of TBI (Fann et al, 2009).…”

Section: Discussionmentioning

confidence: 96%

Health Care Costs Associated with Traumatic Brain Injury and Psychiatric Illness in Adults

Rockhill

Jaffe

Zhou

et al. 2012

Journal of Neurotrauma

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A cohort design was used to determine the contribution of traumatic brain injury (TBI) and psychiatric illness to health care costs for adolescents and adults in the 3 years following mild or moderate-to-severe TBI compared to a matched cohort without TBI, controlling for confounders. In all, 3756 subjects 15 years or older from a large health maintenance organization database were examined. We identified subjects who sustained a TBI in 1993 (n = 939) and selected three control subjects per TBI-exposed subject (n = 2817), matched for age, sex, and enrollment at the time of injury. Unadjusted mean costs in 2009-adjusted dollars were compared using Kruskal-Wallis tests and Mann-Whitney U tests, and adjusted mean costs were compared using gamma regression analyses. Average costs were 76% higher in the 3 years after injury for the mild TBI group, and 5.75 times greater for the moderate-to-severe TBI group compared to controls. The presence of psychiatric illness was associated with more than doubling of total costs for both inpatient and outpatient non-mental health care. Gamma regression analyses confirmed significantly higher costs in patients with TBI or psychiatric illness. A significant interaction between moderate-to-severe TBI and psychiatric illness indicated a 3.39 times greater cost among patients with both exposures compared with those exposed to moderate-to-severe TBI without psychiatric illness. TBI and psychiatric illness were each associated with significant increases in health care costs; those with the combination of moderate-to-severe TBI and psychiatric illness had much higher costs than any other group.

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The effect of prospective payment on rehabilitative care

Cited by 16 publications

References 34 publications

Poststroke Rehabilitation

Poststroke Rehabilitation

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Health Care Costs Associated with Traumatic Brain Injury and Psychiatric Illness in Adults

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