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Rehabilitation costs: implications for prospective payment

R E Schlenker, A M Kramer, C A Hrincevich

    Health Services Research
    |December 24, 1997
    PubMed
    Summary

    Rehabilitation facilities (RFs) used more ancillary resources than skilled nursing facilities (SNFs) for Medicare patients, particularly stroke cases. Integrated payment models for both settings are recommended.

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    Area of Science:

    • Health Services Research
    • Healthcare Economics
    • Geriatric Medicine

    Background:

    • Medicare prospective payment systems aim to standardize reimbursement for post-acute care.
    • Rehabilitation facilities (RFs) and skilled nursing facilities (SNFs) provide distinct post-acute care settings.
    • Understanding resource utilization differences is crucial for payment model development.

    Purpose of the Study:

    • Compare service utilization, length of stay, case mix, and resource consumption between RFs and SNFs for Medicare patients.
    • Inform the development of prospective payment systems for rehabilitation and skilled nursing facilities.

    Main Methods:

    • Longitudinal analysis of Medicare hip fracture and stroke patients (n=996) admitted to RFs and SNFs.
    • Two-group comparisons of RFs versus SNFs, with regression analysis to adjust for patient case mix and other factors.

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  • Data collected on patient case mix, service utilization, and resource consumption.

    • Main Results:

    • RF patients had shorter lengths of stay but higher ancillary resource consumption per stay compared to SNF patients.
    • Ancillary resource differences were more pronounced for stroke patients.
    • Adjusted nursing resource consumption differences were smaller and not statistically significant for hip fracture patients.

    Conclusions:

    • An integrated approach to developing prospective payment for RFs and SNFs is beneficial.
    • Condition-specific per-stay payment methods applicable to both settings warrant consideration.
    • Differences in resource consumption highlight the need for nuanced payment strategies.