Outcomes and reimbursement of inpatient rehabilitation services for Medicare beneficiaries with stroke and hip fracture

Objective. To assess whether outcomes and reimbursement differ for Medicare beneficiaries with a stroke or hip fracture when treated in an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF) based rehabilitation program.; Design. Retrospective cohort study in which patients' clinical outcome data and Medicare payment data were linked.; Participants. The study included 29,793 Medicare beneficiaries with a hip fracture and 58,724 beneficiaries with a stroke who were treated in 1996 or 1997 in a rehabilitation facility that subscribed to the Uniform Data System for Medical Rehabilitation.; Outcomes measures. Discharge destination following the rehabilitation stay and discharge motor Functional Independence Measure (FIM) ratings after adjustment for various patient- and facility-level characteristics; Medicare Part A reimbursement stratified by Case-Mix Group (CMG).; Results. Among older patients with hip fracture in CMGs 701 to 703 and all patients in CMGs 704 and 705, those treated in IRFs were less likely to return to the community. Adjusted odds ratios ranged from 0.73 (95% CI: 0.63 to 0.84) to 0.82 (95% CI: 0.68 to 0.98). For younger patients in CMGs 701 to 703, the percent of patients discharged to the community was not different.{09}Discharge functional status for patients with hip fracture was not clinically different. Across all CMGs, the IRF Medicare payments were higher than SNF payments by 54 to 73 percent.; For all patients with stroke in CMGs 101 to 107, and younger patients in CMGs 108 to 114, those treated in IRFs were more likely to return to the community. Adjusted odds ratios ranged from 1.42 (95% CI: 1.15 to 1.74) to 1.61 (95% CI: 1.22 to 2.11). The functional status of patients in CMGs 101 to 107 was not clinically different, but for patients in CMGs 108 to 114, those treated in IRFs achieved more independence by discharge. Across all CMGs, the IRF Medicare payments were higher than SNF payments by 79 to 117 percent.; Conclusion. Patients with hip fracture achieved equal or better outcomes in SNF-based rehabilitation programs at a lower cost. Patients with stroke achieved better outcomes when treated in IRFs at a higher cost.