Inpatient Rehabilitation Hospital Patients Have Better Outcomes, Live Longer

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.