title: Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury.
abstract: OBJECTIVE
  To examine the impact of Medicare's inpatient rehabilitation facility (IRF) prospective payment system (PPS) on inpatient rehabilitation outcomes for patients with traumatic spinal cord injury (SCI).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Twelve SCI Model Systems.
  
  
  METHODS
  A sample of Medicare (n=296) and non-Medicare (n=3110) patients was selected from the National SCI Statistical Center Database from 1996 to 2006.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Motor FIM score change and length of stay (LOS).
  
  
  RESULTS
  LOS decreased by about 5.8 days a year (P<.001) for Medicare patients and about 1.3 days a year (P=.031) for non-Medicare patients after PPS implementation. However, for both groups, FIM score gains were not significantly different in the pre-PPS and PPS periods.
  
  
  CONCLUSIONS
  Although significant decreases in LOS were observed for Medicare patients after IRF PPS implementation, Medicare patients' improvements in motor function did not decrease. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient rehabilitation care before PPS implementation. IRF PPS implementation was associated with shorter stays, but was not associated with lower functional improvement.
authors.affiliation: Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA. hyqu@uab.edu
authors.forename: Haiyan
authors.initials: H
authors.lastname: Qu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Shewchuk
authors.forename: Yuying
authors.initials: Y
authors.lastname: Chen
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States