Health Services Research DRRP on Medical Rehabilitation

Overview

Why is this study needed?

Medicare’s new prospective payment system (PPS) for inpatient rehabilitation facilities (IRF) may limit effective access to rehabilitation because providers will take fewer risks with patients deemed to be “high cost” patients, hire more “therapy extenders” such as rehabilitation therapy aids rather than licensed professionals and discharge patients at a higher rate to skilled nursing facilities. Disability advocates have reason to be concerned: these unintended consequences may reduce quality of life and independent living of individuals with disabilities if fewer patients are admitted to inpatient rehabilitation or receive lower quality or fewer rehabilitation services. The introduction of PPS in other health care sectors resulted in quite specific responses to the new financial incentives: denial of services, cost shifting to other payers and premature discharge.

How will this study help patients and rehabilitation stakeholders?

This information will help disability advocates and providers appreciate the nationwide effects of prospective payment on access, organization and delivery of medical rehabilitation services.

What are the project objectives?

1. Examine changes in the organization of medical rehabilitation in response to prospective payment (PPS),
2. Examine changes in patient access to medical rehabilitation settings and services resulting from organizational changes and organizational responses to the change in reimbursement,
3. Examine the impact of PPS-related changes in service delivery on patient outcomes,
4. Identify the impact of comorbidities on classification and reimbursement in medical rehabilitation PPS.

How will the project objectives be achieved?

• Objective 1: Organization of Medical Rehabilitation
  This study examines changes in the organization of inpatient rehabilitation facilities (IRFs) in response to PPS.
• Objective 2: Access to Medical Rehabilitation
  This study examines changes in patient access to medical rehabilitation settings resulting from organizational responses to the change in reimbursement. The introduction of PPS for medical rehabilitation is expected to impact utilization patterns across the post-acute care continuum both prior to and after the IRF stay. We will use hospital-level and patient-level data to examine pre- to post-PPS changes in access, length-of-stay and other health services utilization.
• Objective 3: Patient Outcomes
  This study examines the impact of PPS-related changes in service delivery on patient outcomes.
• Objective 4:Comorbidities
  This study examines the impact of comorbidities on classification and reimbursement in medical rehabilitation PPS.
  

What agency funded the project?

National Institute on Disability and Rehabilitation Research (NIDRR)

NIDDR Grant Number: H133A030807

What is the duration of the project?

July 01, 2003 - June 30, 2008

Project Staff

Principal Investigator:

Allen Heinemann, Ph.D., Rehabilitation Institute of Chicago

Co-Investigators:

Deborah Dobrez, Ph.D., University of Illinois at Chicago
Elizabeth Durkin, Ph.D., Northwestern University
Trudy Mallinson, Ph.D., Rehabilitation Institute of Chicago
Larry Manheim, Ph.D.,  Northwestern University
Orit Almagor, MA, Northwestern University
Anne Deutsch, Ph.D., Rehabilitation Institute of Chicago
Patrick Semik, Rehabilitation Institute of Chicago

Related Project Research Web Sites

National Institute on Disability and Rehabilitation Research (NIDRR)
National Rehabilitation Information Center (NARIC)

Contact Information

For researchers and students
Allen Heinemann, Ph.D.
312-238-2802

For members of the media
312-238-6044