Cost differences in VHA acute and subacute rehabilitation units: Implications for VHA resource planning

Abstract

Abstract-Within the Veterans Health Administration (VHA), the top tier of postacute rehabilitation care is provided in acute rehabilitation bedservice units (ARBUs). The next level of care is provided in subacute rehabilitation bedservice units (SRBUs). We fitted reduced-form and structural models to explain VHA cost differences between ARBUs and SRBUs across time and for the individual cost components. We included sociodemographic variables, time since stroke onset, care facility, and the Functional Independence Measure at admission as explanatory variables. The multivariable results indicate that total index stay costs are lower in ARBUs by almost $6,000 (or approximately 25%) compared with SRBUs. Moreover, the lower costs observed in ARBUs in this study combined with the higher rates of guideline compliance and improved outcomes in ARBUs found in previous work suggest that stroke rehabilitation in an ARBU may be more cost-effective than stroke rehabilitation in an SRBU.

Factors Associated with Late Specialized Rehabilitation Among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

“…Subsequently, we found that patients who received specialized services during the immediate postoperative time period were more likely to be discharged home, receive a prescription for a prosthetic limb, and make higher functional gains according to their discharge FIM™ scores compared to patients who received consultative rehabilitation services only while on general bed sections 6. Moreover, based on VHA's “Prescription for Change” initiative, there has been a 47% reduction in the SRUs over an 8 year time period 33, 34. Our unadjusted findings suggesting that patients in the second wave were more likely to only receive immediate postoperative rehabilitation services and be discharged alive are consistent with the reduction of access.…”

Initial Physical Grades and Cognitive Stages After Acute Stroke: Who Receives Comprehensive Rehabilitation Services?

“…Yet, only a small proportion of those evaluated by consulting PM&R staff (11.2%) were admitted to an SRU despite level 1 evidence that supports the provision of higher intensity rehabilitation for stroke [23‐25]. The availability of comprehensive stroke rehabilitation is changing dramatically in the United States, with reductions of SRU beds by the VHA over the past several decades [26]. Also in the private sector, functional status gains after stroke among those treated in IRFs are declining and institutional discharges are increasing as rehabilitation lengths of stays are declining [27].…”