Abstract
Objective
To estimate the proportion of patients with ischemic stroke who fall within and above
the total outpatient rehabilitation caps before and after the Balanced Budget Act
of 1997 took effect; and to estimate the cost of poststroke outpatient rehabilitation
cost and resource utilization in these patients before and after the implementation
of the caps.
Design
Retrospective cohort study.
Setting
Medicare reimbursement system.
Participants
Medicare beneficiaries from the state of South Carolina: the 1997 stroke cohort sample
(N=2667) and the 2004 stroke cohort sample (N=2679).
Interventions
Not applicable.
Main Outcome Measures
Proportion of beneficiaries with bills within and above the cap before and after the
cap was enacted, and total estimated 1-year rehabilitation Medicare payments before
and after the cap.
Results
The proportion of patients with stroke exceeding the cap in 2004 after the Balanced
Budget Act of 1997 was enacted was significantly lower (5.8%) than those in 1997 (9.5%)
had there been a cap at that time (P=.004). However, when the proportion of individuals exceeding the cap among both the
outpatient provider and facility files was examined, there was a greater proportion
of patients with stroke in 2004 (64.6%) than in 1997 (31.9%) who exceeded the cap
(P<.0001). The estimated average 1-year Medicare payments for rehabilitation services,
when examining only the Part B outpatient provider bills, did not differ between the
cohorts (P=.12), and in fact, decreased slightly from $1052 in 1997 to $833 in 2004. However,
when examining rehabilitation costs using all available outpatient Medicare bills,
the average estimated payments greatly increased (P<.0001) from $5691 in 1997 to $9606 in 2004.
Conclusions
These findings suggest that billing practices may have changed after outpatient rehabilitation
services caps were enacted by the Balanced Budget Act of 1997. Rehabilitation services
billing may have shifted from Part B provider bills to being more frequently included
in facility charges.
Keywords
List of abbreviations:
CCI (Charlson Comorbidity Index), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), SAF (Standard Analytical File)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 28, 2015
Footnotes
Support for the data acquisition for this study was provided by the South Carolina Excellence Center to Eliminate Ethnic/Racial Disparities funded by the Agency for Healthcare Research and Quality (grant no. Data Use Agreement 16339).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
