Potential impact of the new medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation.
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.
Hoffman
Jeanne M
JM
Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA. jeanneh@u.washington.edu
Doctor
Jason N
JN
Chan
Leighton
L
Whyte
John
J
Jha
Amit
A
Dikmen
Sureyya
S
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