Association between 2010 Medicare Reforms and Utilization of Post-Acute Inpatient Rehabilitation in Ischemic Stroke.

Ifejika, Nneka; Vahidy, Farhaan; Reeves, Mathew; Xian, Ying; Liang, Li; Matsouaka, Roland; Fonarow, Gregg C; Savitz, Sean I

OBJECTIVE Investigate whether the elimination of trial admissions and the initiation of documentation requirements, via the 2010 Centers for Medicare and Medicaid Services (CMS) Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Rule, limited IRF access while increasing skilled nursing facility (SNF) utilization compared to home discharge (HD) in ischemic stroke (IS) patients. DESIGN Retrospective observational study using Get with the Guidelines - Stroke hospital data between 1/1/2008 and 12/31/2015 (n=1,643,553). RESULTS Between 1/1/2008 and 12/31/2009, 54.1% of patients went home, 25.4% to IRF, 20.5% to SNF. Between 1/1/2010 and 12/31/2015, there was a 1.4% absolute increase in HD, a 1.1% IRF decline, and a 0.3% SNF decline.Within the 1.1% absolute decline in IRF discharge, the adjusted odds of IRF versus HD decreased 12% post 2010 Rule (aOR 0.88, 95% CI 0.87 - 0.89; P<0.0001). There was no statistically significant change in SNF versus HD.Lower adjusted odds of IRF discharge versus HD were identical across age groups and were present in all geographic regions. CONCLUSIONS In populations with ischemic stroke, the CMS 2010 IRF PPS Rule was associated with a 1.1% absolute decrease in IRF discharge, with a concomitant increase in HD rather than to SNF.