Original articleImpact of Medicare Prospective Payment System on Acute Rehabilitation Outcomes of Patients With Spinal Cord Injury
Section snippets
Participants
The data used in this study were retrieved from the NSCID, which has existed since 1973 and is believed to capture data from about 13% of new SCI cases every year in the United States. The NSCID contains data from 26 federally funded SCIMSs, including demographic and medical variables, functional status, and psychosocial outcomes, during the initial hospital care and follow-up data at 1, 5, and then every 5 years postinjury.12, 13
The present study includes patients who received acute inpatient
Results
Of 3406 eligible patients, 296 (8.7%) had Medicare as a primary payer. Table 1 lists characteristics of Medicare and non-Medicare patients by PPS status. There were no significant differences in age, sex, race, highest education level achieved, marital status, and admission FIM motor scores before/after PPS implementation between Medicare and non-Medicare patients. A slightly higher percentage of complete paraplegia and lower percentage of incomplete paraplegia before PPS (vs PPS) were observed
Discussion
The IRF PPS was introduced by the Centers for Medicare & Medicaid Services as a strategy to decrease health care costs by improving the efficiency of rehabilitation care for Medicare beneficiaries in an inpatient setting. The intent of the IRF PPS is to encourage IRFs to allocate and use resources more efficiently.2, 3 To keep facility costs at less than Medicare payments, facilities may decrease individual patient costs by decreasing LOSs, a practice documented by previous studies.21, 22, 23,
Conclusions
Although Medicare patients with SCI who received inpatient rehabilitation care after PPS implementation had significantly shorter stays than those who received rehabilitation care before PPS implementation, motor FIM score gains for Medicare patients with SCI did not decrease with the shortened LOS. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient
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2022, Archives of Physical Medicine and RehabilitationCitation Excerpt :The FIM instrument was developed to assess a person's level of disability in terms of burden of care.23 Using FIM data, we created the outcome measure change in mFIM, which includes 12 items covering self-care, sphincter control, transfers, and locomotion dimensions.24,25 In this study, the tub/shower transfer item was excluded from transfers because scores have been shown to vary based on the environment (use of roll-in shower or tub) and thus may not always reflect a person's level of disability.26
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2015, Archives of Physical Medicine and RehabilitationCurrent research outcomes from the spinal cord injury model systems
2011, Archives of Physical Medicine and RehabilitationRestructuring a Rehabilitation Program for Older Adults: Effects on Patient Outcomes and Staff Perspectives
2013, Canadian Journal on AgingImportance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care
2023, Journal of Neurotrauma
Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, U.S. Department of Education, Washington, DC (grant nos. H133A060039 and H133N060014).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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