Relationship Between Diabetes Codes That Affect Medicare Reimbursement (Tier Comorbidities) and Outcomes in Stroke Rehabilitation
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.
fUniform Data System for Medical Rehabilitation, Buffalo, NY
Correspondence to James E. Graham, PhD, DC, University of Texas Medical Branch, Div of Rehabilitation Sciences, 301 University Blvd, Galveston, TX 77555-1137
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.
ABSTRACT