Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1110-1116, July 2009

Relationship Between Diabetes Codes That Affect Medicare Reimbursement (Tier Comorbidities) and Outcomes in Stroke Rehabilitation

  • James E. Graham, PhD, DC

      Affiliations

    • Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
    • Corresponding Author InformationCorrespondence to James E. Graham, PhD, DC, University of Texas Medical Branch, Div of Rehabilitation Sciences, 301 University Blvd, Galveston, TX 77555-1137
    • ,
  • Cynthia M. Ripsin, MS, MPH, MD

      Affiliations

    • Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
    • ,
  • Anne Deutsch, RN, PhD, CRRN

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL
    • ,
  • Yong-Fang Kuo, PhD

      Affiliations

    • Department of Internal Medicine—Geriatrics, University of Texas Medical Branch, Galveston, TX
    • Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
    • ,
  • Sam Markello, PhD

      Affiliations

    • Uniform Data System for Medical Rehabilitation, Buffalo, NY
    • ,
  • Carl V. Granger, MD

      Affiliations

    • Uniform Data System for Medical Rehabilitation, Buffalo, NY
    • ,
  • Kenneth J. Ottenbacher, PhD, OTR

      Affiliations

    • Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
    • Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX

Abstract 

Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.

Objectives

To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.

Design

Secondary data analysis.

Setting

Inpatient rehabilitation facilities (N=864) across the United States.

Participants

Patients (N=135,097) who received medical rehabilitation for stroke in 2002–2003.

Intervention

None.

Main Outcome Measures

Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.

Results

Mean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.

Conclusions

The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age.

Key Words: Diabetes mellitus, Prospective payment system, Rehabilitation, Stroke

List of Abbreviations: ICD-9, International Classification of Disease, 9th edition, IRF-PAI, Inpatient Rehabilitation Facility—Patient Assessment Instrument, IRF-PPS, Inpatient Rehabilitation Facility—Prospective Payment System, UDSmr, Uniform Data System for Medical Rehabilitation

 

 Supported by the National Institutes of Health (grant no. K02-AG019736) and the National Institute on Disability and Rehabilitation Research (grant nos. H133G080163, H133P040003, and H133A030807).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00209-3

doi:10.1016/j.apmr.2009.01.014

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1110-1116, July 2009

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