Article

OBJECTIVE: To estimate the effect of Medicare's prospective payment system for
inpatient rehabilitation facilities on discharge functional status, community
discharge, and length of stay. DESIGN: Secondary analysis using data drawn from
the American Medical Rehabilitation Providers Association subscription database.
Eligible patients were Medicare and non-Medicare stroke patients discharged from
inpatient rehabilitation facilities from 1998 through the first two quarters of
2006. Random effects panel data models were used to estimate the impact of
prospective payment on motor and cognitive discharge function, the probability of
discharge to the community and inpatient length of stay, controlling for patient,
and facility characteristics. RESULTS: The introduction of prospective payment
was associated with small, statistically significant reductions in Functional
Independence Measure discharge motor (-1.10) and cognitive (-0.15) scores and in
the probability of discharge to the community
(adjusted odds ratio: 0.87) for
Medicare fee-for-service patients. Length of stay was substantially lower for
both Medicare (-1.86 days) and (-2.16) non-Medicare fee-for-service patients.
CONCLUSIONS: Further research is needed to determine whether the small reductions
in patient function are persistent over time. This short-term evaluation of
prospective payment system suggests minimal negative impact on stroke patient
function at discharge because of the change in Medicare reimbursement but a
decrease in likelihood of discharge to the community.

Langue : ANGLAIS