Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.
OBJECTIVE
To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.


METHODS
Secondary data analysis.


METHODS
Inpatient rehabilitation facilities (N=864) across the United States.


METHODS
Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.


METHODS
None.


METHODS
Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.


RESULTS
Mean +/- standard deviation age of the sample was 70.4+/-13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.


CONCLUSIONS
The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age.
Graham
James E
JE
Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555-1137, USA. jegraham@utmb.edu
Ripsin
Cynthia M
CM
Deutsch
Anne
A
Kuo
Yong-Fang
YF
Markello
Sam
S
Granger
Carl V
CV
Ottenbacher
Kenneth J
KJ
D000367:Age Factors; D048909:Diabetes Complications; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare / Q000458:organization & administration*; D010351:Patient Discharge; D011445:Prospective Payment System / Q000458:organization & administration*; D020127:Recovery of Function; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014481:United States