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 language | English (US) |
|---|---|
| Pages (from-to) | 892-901 |
| Number of pages | 10 |
| Journal | Medical Care |
| Volume | 43 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2005 |
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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 journal › Article
}
TY - JOUR
T1 - Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for medicare beneficiaries with hip fracture
AU - Deutsch, Anne
AU - Granger, Carl V.
AU - Fiedler, Roger C.
AU - DeJong, Gerben
AU - Kane, Robert L.
AU - Ottenbacher, Kenneth
AU - Heinemann, Allen W.
AU - Naughton, John P.
AU - Trevisan, Maurizio
PY - 2005/9
Y1 - 2005/9
N2 - 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.
AB - 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.
KW - Hip fracture
KW - Outcomes
KW - Rehabilitation
KW - Reimbursement
UR - http://www.scopus.com/inward/record.url?scp=24944524805&partnerID=8YFLogxK
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U2 - 10.1097/01.mlr.0000173591.23310.d5
DO - 10.1097/01.mlr.0000173591.23310.d5
M3 - Article
VL - 43
SP - 892
EP - 901
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 9
ER -