Perspectives on the State-of-the-Science in Rehabilitation Medicine and Its Implications for Medicare Postacute Care Policies

Abstract

Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings. KeywordsHealth care reform; Medicare; Prospective payment system; Rehabilitation; Treatment outcomes THE ISSUES DISCUSSED at the State-of-the-Science Symposium held in February 2007 and in the November 2007 issue of Archives are key to the development of sound health policy. We lack an instrument that allows us to compare patient outcomes across postacute care (PAC) settings in an evidence-based manner. This instrument is needed to measure the relative value of rehabilitation and medical services delivered by PAC providers, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), home health agencies (HHAs), and outpatient settings. As the differences in staffing and care practices become blurred across the different types of

Patterns of Rehabilitation After Hip Arthroplasty and the Association with Outcomes

“…Gage et al 9 analyzed five diagnoses or procedure groups and found that half of these patients used more than one type of rehabilitation setting. DeJong et al 10 found that 92% of hip and knee arthroplasty patients continue to receive rehabilitation services after discharge from an SNF or an IRF.…”

Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care

“…The change-in-functional-status data items added to the MDS came from the CARE Tool item set. Gage et al (2007) reported on the development of the CARE Tool, developed by CMS through a contract to RTI International to develop a PAC assessment tool for use in all PAC settings. The Post-Acute Care Payment Reform Demonstration tested the CARE Tool from 2008 to 2009 and finalized its development.…”

“…The Post-Acute Care Payment Reform Demonstration tested the CARE Tool from 2008 to 2009 and finalized its development. Although the CARE Tool has not been implemented in its entirety, Gage et al (2012) established its reliability.…”

“…The quest for more and better data on which patients went to which PAC settings and why led to the development of the Continuity Assessment Record and Evaluation (CARE) Tool (Gage et al, 2012). The CARE Tool is now being used in part as an item bank for uniform PAC assessment data collection.…”

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“…Third, the Centers for Medicare and Medicaid Services (CMS) Innovations Center has spearheaded the Partnership for Patients, testing innovative programs that will address the issues. For example, one initiative targets long‐stay dually eligible NH residents by contracting with seven organizations to assist 145 NHs with implementation of evidence‐based interventions and additional on‐site assistance to reduce unnecessary hospitalizations in this population . The 3‐day hospital requirement for SNF‐level care for individuals who meet specific clinical criteria may be modified in these new models.…”