title: Potential impact of the new medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation.
abstract: OBJECTIVE
  To evaluate the potential impact of the new Medicare prospective payment system (PPS) on traumatic brain injury (TBI) rehabilitation.
  
  
  METHODS
  Retrospective cohort study of patients with TBI. Patients were assigned to their appropriate case-mix group (CMG) based on Medicare criteria.
  
  
  METHODS
  Fourteen urban rehabilitation facilities throughout the United States.
  
  
  METHODS
  Patients with TBI admitted to inpatient rehabilitation and enrolled in the Traumatic Brain Injury Model Systems from 1998 to 2001 (N=1807).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes.
  
  
  RESULTS
  The median cost of inpatient rehabilitation for patients with TBI exceeded median PPS payments for all TBI CMGs by 16%. Only 3 of the 14 hospitals received reimbursement under PPS that exceeded costs for their TBI patients.
  
  
  CONCLUSIONS
  Compared with current costs, the new Medicare payment system may reimburse facilities significantly less than their costs for the treatment of TBI. To maintain their current financial status, facilities may have to reduce LOS and/or reduce resource use. With a decreased LOS, inpatient rehabilitation services will have to improve FIM efficiency or discharge patients with lower discharge FIM scores.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. jeanneh@u.washington.edu
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: Jason N
authors.initials: JN
authors.lastname: Doctor
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Amit
authors.initials: A
authors.lastname: Jha
authors.forename: Sureyya
authors.initials: S
authors.lastname: Dikmen
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000191:economics* / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D018166:Health Care Reform / Q000191:economics; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge; D011445:Prospective Payment System; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States