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(Stroke. 2006;37:1477.)
© 2006 American Heart Association, Inc.

Original Contributions

Poststroke Rehabilitation

Outcomes and Reimbursement of Inpatient Rehabilitation Facilities and Subacute Rehabilitation Programs

Anne Deutsch, PhD, RN, CRRN; Carl V. Granger, MD; Allen W. Heinemann, PhD, ABPP; Roger C. Fiedler, PhD; Gerben DeJong, PhD; Robert L. Kane, MD; Kenneth J. Ottenbacher, PhD, OTR; John P. Naughton, MD Maurizio Trevisan, MD, MPH

From the Department of Rehabilitation Medicine (C.V.G., J.P.N.), School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York and Uniform Data System for Medical Rehabilitation, Amherst, NY; the Department of Physical Medicine and Rehabilitation (A.W.H.), Feinberg School of Medicine, Northwestern University and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Academic Affairs (R.C.F.), D’Youville College, Buffalo, NY; National Rehabilitation Hospital Research (G.D.), National Rehabilitation Hospital, Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC; Health Services Research and Policy (R.L.K.), University of Minnesota, Minneapolis, MN; the University of Texas Medical Branch (K.J.O.), Galveston, TX; and the School of Public Health and Health Professions (M.T.), University at Buffalo, The State University of New York, Buffalo, NY.

Correspondence to Anne Deutsch, PhD, RN, CRRN, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 East Superior St, Chicago, IL 60611-2654. E-mail a-deutsch{at}northwestern.edu

Background and Purpose— To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs.

Methods— Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay.

Results— IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups.

Conclusions— For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

Key Words: cerebrovascular accident • outcomes • rehabilitation