Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for medicare beneficiaries with hip fracture

Anne Deutsch, Carl V. Granger, Roger C. Fiedler, Gerben DeJong, Robert L. Kane, Kenneth Ottenbacher, Allen W. Heinemann, John P. Naughton, Maurizio Trevisan

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: We sought to assess whether outcomes and reimbursement differ for Medicare beneficiaries with hip fracture when treated in an inpatient rehabilitation facility (IRF) compared with a skilled nursing facility (SNF) subacute rehabilitation program. Participants: Clinical data were linked with Medicare claims for 29,793 Medicare fee-for-service beneficiaries with a recent hip fracture who completed treatment in 1996 or 1997 in rehabilitation facilities that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome Measures: We measured discharge destination, change in motor FIM™ rating, and Medicare Part A reimbursement. Results: For patients with moderate-to-severe and severe disabilities, case mix groups (CMGs) 704 and 705, the percentage of patients discharged to the community from IRFs was lower than for patients treated in subacute rehabilitation SNFs, after controlling for covariates. Adjusted odds ratios were 0.71 (95% confidence interval 0.55-0.92) for CMG 704 and 0.72 (95% confidence interval 0.63-0.83) for CMG 705. For patients in the 3 other CMGs, no significant differences were detected. Improvement in motor functional status was roughly equivalent for patients treated in IRFs and those treated in the subacute rehabilitation programs across all 5 CMGs, after controlling for covariates. Medicare Part A payments for IRFs were significantly higher than SNF payments across all CMGs. Conclusion: SNF-based subacute rehabilitation was less costly and outcomes were in most, but not all, instances similar or better than IRF-based rehabilitation for Medicare fee-for-service beneficiaries who had a recent hip fracture.

Original languageEnglish (US)
Pages (from-to)892-901
Number of pages10
JournalMedical Care
Volume43
Issue number9
DOIs
StatePublished - Sep 2005

Fingerprint

Hip Fractures
Medicare
rehabilitation
Inpatients
Rehabilitation
Diagnosis-Related Groups
Skilled Nursing Facilities
Medicare Part A
nursing
Group
Fee-for-Service Plans
fee
medical rehabilitation
confidence
Confidence Intervals
severe disability
Information Systems
rating
Odds Ratio
Outcome Assessment (Health Care)

Keywords

  • Hip fracture
  • Outcomes
  • Rehabilitation
  • Reimbursement

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for medicare beneficiaries with hip fracture. / Deutsch, Anne; Granger, Carl V.; Fiedler, Roger C.; DeJong, Gerben; Kane, Robert L.; Ottenbacher, Kenneth; Heinemann, Allen W.; Naughton, John P.; Trevisan, Maurizio.

In: Medical Care, Vol. 43, No. 9, 09.2005, p. 892-901.

Research output: Contribution to journalArticle

Deutsch, Anne ; Granger, Carl V. ; Fiedler, Roger C. ; DeJong, Gerben ; Kane, Robert L. ; Ottenbacher, Kenneth ; Heinemann, Allen W. ; Naughton, John P. ; Trevisan, Maurizio. / Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for medicare beneficiaries with hip fracture. In: Medical Care. 2005 ; Vol. 43, No. 9. pp. 892-901.
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