Abstract
Hoffman JM, Doctor JN, Chan L, Whyte J, Jha A, Dikmen S. Potential impact of the new
Medicare prospective payment system on reimbursement for traumatic brain injury inpatient
rehabilitation. Arch Phys Med Rehabil 2003;84:1165–72.
Objective:
To evaluate the potential impact of the new Medicare prospective payment system (PPS)
on traumatic brain injury (TBI) rehabilitation.
Design:
Retrospective cohort study of patients with TBI. Patients were assigned to their appropriate
case-mix group (CMG) based on Medicare criteria.
Setting:
Fourteen urban rehabilitation facilities throughout the United States.
Participants:
Patients with TBI admitted to inpatient rehabilitation and enrolled in the Traumatic
Brain Injury Model Systems from 1998 to 2001 (N=1807).
Interventions:
Not applicable.
Main Outcome Measures:
Cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes.
Results:
The median cost of inpatient rehabilitation for patients with TBI exceeded median
PPS payments for all TBI CMGs by 16%. Only 3 of the 14 hospitals received reimbursement
under PPS that exceeded costs for their TBI patients.
Conclusions:
Compared with current costs, the new Medicare payment system may reimburse facilities
significantly less than their costs for the treatment of TBI. To maintain their current
financial status, facilities may have to reduce LOS and/or reduce resource use. With
a decreased LOS, inpatient rehabilitation services will have to improve FIM efficiency
or discharge patients with lower discharge FIM scores.
Keywords
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Article info
Footnotes
☆Supported by the National Center for Medical Rehabilitation Research (grant no. T32 HD07424) and National Institute on Disability and Rehabilitation Research through the Traumatic Brain Injury Model Systems project. The views expressed herein are those of the authors and not necessarily of the University of Washington, Moss Rehabilitation Research Institute, or Craig Hospital.
Identification
Copyright
© 2003 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
