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Impact of Medicare's Prospective Payment System for Inpatient Rehabilitation Facilities on Stroke Patient Outcomes

Dobrez, Deborah, PhD; Heinemann, Allen W., PhD; Deutsch, Anne, RN, PhD, CRRN; Manheim, Larry, PhD; Mallinson, Trudy, PhD, OTR/L, NZROT

American Journal of Physical Medicine & Rehabilitation: March 2010 - Volume 89 - Issue 3 - p 198-204
doi: 10.1097/PHM.0b013e3181c9fb40
Original Research Article: Outcomes

Dobrez D, Heinemann AW, Deutsch A, Manheim L, Mallinson T: Impact of Medicare's prospective payment system for inpatient rehabilitation facilities on stroke patient outcomes.

Objective: To estimate the effect of Medicare's prospective payment system for inpatient rehabilitation facilities on discharge functional status, community discharge, and length of stay.

Design: Secondary analysis using data drawn from the American Medical Rehabilitation Providers Association subscription database. Eligible patients were Medicare and non-Medicare stroke patients discharged from inpatient rehabilitation facilities from 1998 through the first two quarters of 2006. Random effects panel data models were used to estimate the impact of prospective payment on motor and cognitive discharge function, the probability of discharge to the community and inpatient length of stay, controlling for patient, and facility characteristics.

Results: The introduction of prospective payment was associated with small, statistically significant reductions in Functional Independence Measure discharge motor (−1.10) and cognitive (−0.15) scores and in the probability of discharge to the community (adjusted odds ratio: 0.87) for Medicare fee-for-service patients. Length of stay was substantially lower for both Medicare (−1.86 days) and (−2.16) non-Medicare fee-for-service patients.

Conclusions: Further research is needed to determine whether the small reductions in patient function are persistent over time. This short-term evaluation of prospective payment system suggests minimal negative impact on stroke patient function at discharge because of the change in Medicare reimbursement but a decrease in likelihood of discharge to the community.

From the Division of Health Policy and Administration, University of Illinois at Chicago (DD); the Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago (AWH, AD, TM), Chicago, Illinois; and the Institute for Healthcare Studies, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University (LM), Evanston, Illinois.

All correspondence and requests for reprints should be addressed to Deborah Dobrez, PhD, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612.

Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Funding for this study was provided by a Health Services Research Disability and Rehabilitation Research Project on Medical Rehabilitation (H133A030807) awarded by the National Institute on Disability and Rehabilitation Research to the Rehabilitation Institute of Chicago (to A. W. H., project director). Sam Fleming, President of Fleming-AOD, Inc., facilitated access to the eRehabData files from inpatient rehabilitation facilities.

© 2010 Lippincott Williams & Wilkins, Inc.