title: Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs for Medicare beneficiaries with hip fracture.
abstract: OBJECTIVE
  We sought to assess whether outcomes and reimbursement differ for Medicare beneficiaries with hip fracture when treated in an inpatient rehabilitation facility (IRF) compared with a skilled nursing facility (SNF) subacute rehabilitation program.
  
  
  METHODS
  Clinical data were linked with Medicare claims for 29,793 Medicare fee-for-service beneficiaries with a recent hip fracture who completed treatment in 1996 or 1997 in rehabilitation facilities that subscribed to the Uniform Data System for Medical Rehabilitation.
  
  
  METHODS
  We measured discharge destination, change in motor FIM rating, and Medicare Part A reimbursement.
  
  
  RESULTS
  For patients with moderate-to-severe and severe disabilities, case mix groups (CMGs) 704 and 705, the percentage of patients discharged to the community from IRFs was lower than for patients treated in subacute rehabilitation SNFs, after controlling for covariates. Adjusted odds ratios were 0.71 (95% confidence interval 0.55-0.92) for CMG 704 and 0.72 (95% confidence interval 0.63-0.83) for CMG 705. For patients in the 3 other CMGs, no significant differences were detected. Improvement in motor functional status was roughly equivalent for patients treated in IRFs and those treated in the subacute rehabilitation programs across all 5 CMGs, after controlling for covariates. Medicare Part A payments for IRFs were significantly higher than SNF payments across all CMGs.
  
  
  CONCLUSIONS
  SNF-based subacute rehabilitation was less costly and outcomes were in most, but not all, instances similar or better than IRF-based rehabilitation for Medicare fee-for-service beneficiaries who had a recent hip fracture.
authors.affiliation: Institute for Health Services Research and Policy Studies, Northwestern University, Chicago, Illinois 60611-3071, USA. a-deutsch@northwestern.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.forename: Carl V
authors.initials: CV
authors.lastname: Granger
authors.forename: Roger C
authors.initials: RC
authors.lastname: Fiedler
authors.forename: Gerben
authors.initials: G
authors.lastname: DeJong
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.forename: John P
authors.initials: JP
authors.lastname: Naughton
authors.forename: Maurizio
authors.initials: M
authors.lastname: Trevisan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006620:Hip Fractures / Q000191:economics* / Q000534:rehabilitation*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D016344:Medicare Part A / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D012047:Rehabilitation Centers / Q000191:economics* / Q000592:standards* / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000191:economics* / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology