Prospective payment for acute care: impact on rehabilitation hospitals

This study assessed rehabilitation workers' perceptions of acute care Medicare prospective payment effects on rehabilitation hospitals and units. Members of four groups--physicians, nurses, social workers, and administrators--were asked to complete a survey of prospective payment effects. All survey participants worked at one of the 373 DRG-exempt rehabilitation hospitals in 46 states that have similar prospective payment systems. A total of 761 persons (60% of the eligible sample) responded with complete answers. Across all groups, respondents reported increases in the frequency of acute illness, as well as increases in complications and readmission into acute care. An increase in the number of referrals for inpatient rehabilitation was also reported, although only minimal changes in the length of rehabilitation stay were perceived. Individuals at rehabilitation hospitals perceived a greater increase in complication and readmission rate and acute illness, whereas individuals at rehabilitation units perceived a greater increase in referrals. Differences among members of the four disciplines were small, with social workers reporting the largest increase in complications and readmission to acute care hospitals, as well as in referrals for inpatient rehabilitation. Implications of these findings for rehabilitation hospitals and units are discussed.