Association Between 2010 Medicare Reforms and Utilization of Postacute Inpatient Rehabilitation in Ischemic Stroke.
Nneka L Ifejika, Farhaan Vahidy, Mathew Reeves and 5 others
PMID 33002913WHAT IT FOUND
Discharges to inpatient rehabilitation facilities dropped 1.1% after 2010 Medicare reforms, while skilled nursing facility discharges remained unchanged.
The adjusted odds of IRF admission fell 12% compared to home discharge. This suggests fewer stroke patients received intensive therapy despite the policy aiming to target complex needs.
Key findings
01The absolute rate of discharge to inpatient rehabilitation facilities declined by 1.1% after the 2010 rule implementation.
02Adjusted odds of discharge to an inpatient rehabilitation facility compared to home were 12% lower in the post-rule period.
03There were no statistically significant differences in discharge to skilled nursing facilities compared to home in the post-rule period.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study could not measure inter-rater reliability in the rehabilitation assessment process, meaning the 'need' for IRF was judged differently by different clinicians. Participating hospitals were often large, urban, and teaching institutions, which may not represent rural or non-teaching hospital populations. Stroke severity (NIHSS) was missing in 28% of cases and excluded from the primary model, introducing potential selection bias in sensitivity analyses. The study did not examine the impact of this shift on actual patient outcomes, such as disability rates or long-term recovery.
Declared interests
None declared by the authors. The study was supported by the National Institutes of Health (N.I.H., Extramural).
The easy way to misread this
Do not interpret the 12% decrease in adjusted odds as a large clinical crisis. The absolute decline in IRF discharges was only 1.1%, and the study did not prove that this reduction led to worse patient outcomes, only that access changed.