TY - JOUR
T1 - Association between 2010 Medicare Reforms and Utilization of Postacute Inpatient Rehabilitation in Ischemic Stroke
AU - Ifejika, Nneka L.
AU - Vahidy, Farhaan
AU - Reeves, Mathew
AU - Xian, Ying
AU - Liang, Li
AU - Matsouaka, Roland
AU - Fonarow, Gregg C.
AU - Savitz, Sean I.
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Objective The aim of the study was to investigate whether the elimination of trial admissions and the initiation of documentation requirements, via the 2010 Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Prospective Payment System Rule, limited inpatient rehabilitation facility access while increasing skilled nursing facility utilization compared with home discharge in ischemic stroke patients. Design This is a retrospective observational study using Get with the Guidelines-Stroke hospital data between January 1, 2008 and December 31, 2015 (N = 1,643,553). Results Between January 1, 2008 and December 31, 2009, 54.1% of patients went home, 25.4% to inpatient rehabilitation facility and 20.5% to skilled nursing facility. Between January 1, 2010 and December 31, 2015, there was a 1.4% absolute increase in home discharge, a 1.1% inpatient rehabilitation facility decline and a 0.3% skilled nursing facility decline. Within the 1.1% absolute decline in inpatient rehabilitation facility discharge, the adjusted odds of inpatient rehabilitation facility versus home discharge decreased 12% after 2010 Rule (adjusted odds ratio = 0.88, 95% confidence interval = 0.87-0.89, P < 0.0001). There was no statistically significant change in skilled nursing facility versus home discharge. Lower adjusted odds of inpatient rehabilitation facility discharge versus home discharge were identical across age groups and were present in all geographic regions. Conclusions In populations with ischemic stroke, the Centers for Medicare and Medicaid Services 2010 Inpatient Rehabilitation Facility Prospective Payment System Rule was associated with a 1.1% absolute decrease in inpatient rehabilitation facility discharge, with a concomitant increase in home discharge rather than to skilled nursing facility.
AB - Objective The aim of the study was to investigate whether the elimination of trial admissions and the initiation of documentation requirements, via the 2010 Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Prospective Payment System Rule, limited inpatient rehabilitation facility access while increasing skilled nursing facility utilization compared with home discharge in ischemic stroke patients. Design This is a retrospective observational study using Get with the Guidelines-Stroke hospital data between January 1, 2008 and December 31, 2015 (N = 1,643,553). Results Between January 1, 2008 and December 31, 2009, 54.1% of patients went home, 25.4% to inpatient rehabilitation facility and 20.5% to skilled nursing facility. Between January 1, 2010 and December 31, 2015, there was a 1.4% absolute increase in home discharge, a 1.1% inpatient rehabilitation facility decline and a 0.3% skilled nursing facility decline. Within the 1.1% absolute decline in inpatient rehabilitation facility discharge, the adjusted odds of inpatient rehabilitation facility versus home discharge decreased 12% after 2010 Rule (adjusted odds ratio = 0.88, 95% confidence interval = 0.87-0.89, P < 0.0001). There was no statistically significant change in skilled nursing facility versus home discharge. Lower adjusted odds of inpatient rehabilitation facility discharge versus home discharge were identical across age groups and were present in all geographic regions. Conclusions In populations with ischemic stroke, the Centers for Medicare and Medicaid Services 2010 Inpatient Rehabilitation Facility Prospective Payment System Rule was associated with a 1.1% absolute decrease in inpatient rehabilitation facility discharge, with a concomitant increase in home discharge rather than to skilled nursing facility.
KW - Inpatient Rehabilitation Facility, Health Reform
KW - Skilled Nursing Facility, Centers for Medicare and Medicaid Services
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85108385802&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108385802&partnerID=8YFLogxK
U2 - 10.1097/PHM.0000000000001605
DO - 10.1097/PHM.0000000000001605
M3 - Article
C2 - 33002913
AN - SCOPUS:85108385802
SN - 0894-9115
VL - 100
SP - 675
EP - 682
JO - American Journal of Physical Medicine and Rehabilitation
JF - American Journal of Physical Medicine and Rehabilitation
IS - 7
ER -