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For-Profit and Not-for-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes

  • Author Footnotes
    1 Dr. Lamm was affiliated with Spaulding Rehabilitation Hospital during data collection and Mary Free Bed at the time of publication.
    Adam G. Lamm
    Footnotes
    1 Dr. Lamm was affiliated with Spaulding Rehabilitation Hospital during data collection and Mary Free Bed at the time of publication.
    Affiliations
    Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
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  • Richard Goldstein
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
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  • Chloe S. Slocum
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA

    Massachusetts General Hospital, Boston, Massachusetts
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  • Julie K. Silver
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA

    Massachusetts General Hospital, Boston, Massachusetts

    Brigham and Women's Hospital, Boston, MA
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  • David C. Grabowski
    Affiliations
    Department of Health Care Policy, Harvard Medical School, Boston, MA
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  • Author Footnotes
    ⁎ Indicates co-senior authorship.
    Jeffrey C. Schneider
    Correspondence
    Corresponding author Ross Zafonte, DO, 300 First Ave, Charlestown, MA 02129.
    Footnotes
    ⁎ Indicates co-senior authorship.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
    Search for articles by this author
  • Author Footnotes
    ⁎ Indicates co-senior authorship.
    Ross D. Zafonte
    Correspondence
    Corresponding author Ross Zafonte, DO, 300 First Ave, Charlestown, MA 02129.
    Footnotes
    ⁎ Indicates co-senior authorship.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA

    Massachusetts General Hospital, Boston, Massachusetts

    Brigham and Women's Hospital, Boston, MA
    Search for articles by this author
  • Author Footnotes
    1 Dr. Lamm was affiliated with Spaulding Rehabilitation Hospital during data collection and Mary Free Bed at the time of publication.
    ⁎ Indicates co-senior authorship.
Published:November 28, 2021DOI:https://doi.org/10.1016/j.apmr.2021.11.003

      Abstract

      Objective

      To describe differences in characteristics and outcomes of patients with traumatic brain injury by inpatient rehabilitation facility (IRF) profit status.

      Design

      Retrospective database review using the Uniform Data System for Medical Rehabilitation.

      Setting

      IRFs.

      Participants

      Individual discharges (N=53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018.

      Intervention

      Not applicable.

      Main Outcome Measures

      Patient demographic data (age, race, primary payer source), admission and discharge FIM, FIM gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status.

      Results

      Patients at for-profit facilities were significantly older (69.69 vs 64.12 years), with lower admission FIM scores (52 vs 57), shorter lengths of stay (13 vs 15 days), and higher discharge FIM scores (88 vs 86); for-profit facilities had higher rates of community discharges (76.8% vs 74.6%) but also had higher rates of readmission (10.3% vs 9.9%).

      Conclusions

      The finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied to determine if differences in patient selection, coding and/or billing, or other unreported factors underlie these differences.

      Keywords

      List of abbreviations:

      IMPACT (Improving Medicare Post-Acute Care Transformation), IRF (inpatient rehabilitation facility), MedPAC (Medicare Payment Advisory Committee), RIC (Rehabilitation Impairment Code), UDSMR (Uniform Data System for Medical Rehabilitation)
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