Study: Inpatient Rehabilitation Hospital Patients Have Better Outcomes, Live Longer

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A new study released today at a meeting of the American Medical Rehabilitation Providers Association (AMRPA) shows that patients treated in inpatient rehabilitation hospitals and units had better long-term clinical outcomes than those treated in nursing homes.1 The study is the most comprehensive national analysis to date examining the long-term outcomes of clinically similar patient populations treated in inpatient rehabilitation hospitals and units or nursing homes.

"This study shows that patients treated in inpatient rehabilitation hospitals and units have better outcomes, go home earlier and live longer than those treated in skilled nursing facilities," said Jon Skinner, Market Executive, Baylor Institute for Rehabilitation (BIR).

"This confirms what we in the patient community have known – timely, intensive and coordinated programs provided in a rehabilitation hospital or unit help return patients to their homes and communities faster than skilled nursing facilities," Skinner said. "Rehabilitation hospitals and units are key to reducing costly hospital readmissions for those with a wide range of disabling conditions."

Policy Implications

Currently, proposals are being considered in Congress to cut or freeze Medicare coverage for inpatient rehabilitation hospitals and units as a way to pay for reform of the Medicare Physician Fee Schedule. The proposals are based on the premise that inpatient rehabilitation hospitals and units and nursing homes are the same. If enacted, the cuts would inappropriately divert patients in need of hospital-level rehabilitation to other settings despite their clinical needs.

"Congress should not be so quick to push patients out of inpatient rehabilitation hospitals or units and into nursing homes.  That would deny many Medicare patients the care they need to more quickly return to their family and community activities," Skinner added. "Policy decisions on medical rehabilitation should prioritize what is best for the patient, not what is the cheapest option."

Baylor Institute for Rehabilitation has joined the 1,165 inpatient rehabilitation hospitals and units nationwide urging Congress to protect patient access to this critical part of the health care system.  BIR hospitals treated 3,972 patients in 2013, of which 2,573 were Medicare patients. If Congress moves forward with these cuts, many providers nationwide – including BIR facilities – that are already subsidizing the cost of caring for Medicare patients, may face serious threats to their ability to keep their doors open to provide the treatment that supports the recovery of individuals with disabling injuries and illnesses.

"Congress must protect patient access to inpatient rehabilitation hospitals and units to ensure Medicare beneficiaries receive the right treatment in the right setting," noted Skinner.

Key Findings

Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities and After Discharge conducted by Dobson DaVanzo & Associates, LLC, studied a national sample of Medicare fee-for-service claims data to compare the clinical outcomes and Medicare payments for patients who received rehabilitation in an inpatient rehabilitation hospital to clinically similar patients in nursing homes.  The study's key findings show:

  • Over a two-year episode of care, inpatient rehabilitation hospital and unit patients clinically comparable to skilled nursing facility patients, on average:
    • Returned home from their initial hospital rehabilitation stay two weeks earlier
    • Remained home nearly two months longer
    • Stayed alive nearly two months longer
  • Of matched patients treated:
    • Inpatient rehabilitation hospital and unit patients showed an 8 percent lower mortality ratethan skilled nursing facility patients
    • Inpatient rehabilitation hospital and unit patients with seven of the 12 diagnostic conditions showed significantly fewer hospital readmissions than skilled nursing facility patients.
    • Inpatient rehabilitation hospital and unit patients made 5 percent fewer emergency room visits per year than skilled nursing facility patients
  • These better clinical outcomes were achieved by inpatient rehabilitation hospitals and units for only an additional cost to Medicare of $12.59 per day.

To see the full study, visit:
http://www.amrpa.org/Newsroom/Final_Dobson_DaVanzo_Report.pdf.

The Role of Inpatient Rehabilitation Hospitals and Units

Medicare pays for approximately 60 percent of all patients treated in inpatient rehabilitation hospitals and units, and strictly regulates and requires highly specialized, carefully coordinated and individualized care to help restore the skills and abilities people need to return home to their families and community activities. Typical conditions treated in these medical rehabilitation hospitals include stroke, brain and spinal cord injury, neurological diseases and major musculoskeletal disorders.

For those patients needing inpatient rehabilitation, nursing homes are virtually unregulated as to how rehabilitation services are provided. The absence of these critical regulatory standards leads to more varied and less intense rehabilitation treatment in the nursing home setting.

While there are many settings in which individual rehabilitation therapy services may be provided, only the most complex and vulnerable patients who need medical rehabilitation are – or should be treated in an inpatient rehabilitation hospital or unit. In fact, rehabilitation hospitals and units currently decline to admit between one-third and one-half of the patients who are referred to be admitted, because the rehabilitation physicians who review these cases determine that the patient could more appropriately be served in an alternative setting.

About the Study

The ARA Research Institute, an affiliate of the American Medical Rehabilitation Providers Association, commissioned Dobson-DaVanzo & Associates, LLC, to conduct a retrospective study of inpatient rehabilitation hospital and unit patients and clinically similar nursing home patients to examine the downstream comparative utilization, effectiveness of post-acute care pathways and total cost of treatment during the five years following the implementation of the 60 percent rule.

Using a 20 percent sample of Medicare beneficiary claims, this study analyzed all Medicare Parts A and B claims across all care settings (excluding physicians and durable medical equipment) from 2005 through 2009. Using statistical matching methods, 100,000 clinically similar pairs of patients were identified. Two-year care episodes were created to track all health care utilization and payments following discharge from an index acute care hospitalization that resulted in a transfer to either an inpatient rehabilitation hospital or unit, or a nursing home. This episode length allowed the capture of the long-term impact of the rehabilitation, including meaningful differences in mortality, use of downstream facility-based care, and patients' ability to remain home.

Study Limitation

Medicare fee-for-service claims do not include care covered and reimbursed by Medicaid and third parties.  Therefore, non-Medicare services, such as long-term nursing home stays, are not captured in this analysis.  This omission may overestimate the calculated number of days a patient remains at home, and underestimate the cost of their health care to the federal and state governments.

About Baylor Institute for Rehabilitation
Since 1981, Baylor Institute for Rehabilitation (BIR) has helped people overcome serious disabilities and return to full, productive lives. BIR's interdisciplinary clinical teams – made up of physicians, nurses, therapists and other rehabilitation professionals – partner with patients and their families to design and implement treatment plans to achieve each patient's unique goals.  BIR has received repeat recognition as one of the country's top rehabilitation hospitals in U.S. News & World Report's annual "America's Best Hospitals" report, and been designated by the National Institute on Disability and Rehabilitation Research as a model system for the treatment and care of patients with traumatic brain injuries. BIR is a joint venture between Baylor Health Care System and Select Medical Corporation and includes four freestanding hospitals – BIR Dallas, BIR NW Dallas, BIR Frisco and BIR Ft. Worth. BIR also manages acute inpatient rehabilitation units at Baylor All Saints Medical Center and Baylor Medical Center at Irving, In addition, BIR operates more than 50 outpatient therapy centers and offers home health services.

About Baylor Scott & White Health
Baylor Scott & White Health is a not-for-profit health care system with total assets of $8.3 billion* and the vision and resources to offer its patients continued quality care while creating a model system for a dramatically changing health care environment. The new system includes 43 hospitals, more than 500 patient care sites, more than 6,000 active physicians, 34,000 employees and the Scott & White Health Plan. For more rel="noopener noreferrer" information visit: www.BaylorScottandWhite.com

*based on unaudited fiscal year 2013 financial statements

1Medicare Part A covers "skilled nursing facilities (SNFs)," commonly called "nursing homes."

 

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