Difference in Clinical Outcomes Demonstrates Why Rehabilitation Hospitals
and Nursing Homes Should Not be Treated the Same by Congress and Medicare
(March 19, 2014) -- A new study released at a meeting of the American Medical
Rehabilitation Providers Association (AMRPA) on March 11, 2014 shows that
patients treated in inpatient rehabilitation hospitals and units had better
long-term clinical outcomes than those treated in nursing homes. 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 Felice L.
Loverso, president and CEO of Casa Colina Centers for Rehabilitation in
Pomona, CA.
"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," said Felice Loverso. "Rehabilitation
hospitals and units are key to reducing costly hospital readmissions for
those with a wide range of disabling conditions."
Policy Implications
Currently, there are proposals 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," added Felice Loverso. "Policy
decisions on medical rehabilitation should prioritize what is best for
the patient, not what is the cheapest option."
Casa Colina Hospital 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. In 2011, acute care hospitals
in Los Angeles, Orange and San Bernardino counties treated 17,144 patients
– patients who could lose access to these critical services. If
Congress moves forward with these cuts, many providers nationwide that
are already subsidizing the cost of caring for Medicare patients will
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," said Felice Loverso.
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 rate than skilled nursing facility patients
-
Inpatient rehabilitation hospital and unit patients with 5 of the 13 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 Casa Colina Centers for Rehabilitation
Casa Colina was founded in 1936 in Chino, CA to provide rehabilitative
care to children with polio. In 1959, it moved to a new facility in Pomona,
CA and expanded its services to treat people of all ages and disabilities
resulting from neurological and/or orthopedic conditions. In recent years,
Casa Colina has renovated its entire 20-acre Pomona campus to include
a state-of-the-art 68-bed acute rehabilitation hospital accredited by
The Joint Commission that includes outpatient and children's services;
post-acute residential care accredited by the Commission for Accreditation
of Rehabilitation Facilities (CARF); adult day health care; specialty
physician's clinics; diagnostic imaging; ambulatory surgery, and more.
The new Casa Colina Medical Office Building opened on the Pomona campus
in June 2013 and construction of a 31-bed medical/surgical hospital wing
is currently underway with a scheduled opening in 2015. It also operates
a freestanding outpatient center in Azusa, CA. For more information, visit
www.casacolina.org.
Medicare Part A covers "skilled nursing facilities (SNFs),"
commonly called "nursing homes."