Potential impact of the new Medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation

Short Title:
Potential impact of the new Medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation
Model System:
TBI
Reference Type:
Journal Article
Accession No.:
J45742.
Journal:
Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):
2003, vol. 84, issue 8, pp 1165-1172
Publication Website:
Abstract:
Study examined the potential impact of Medicare's new prospective payment system (PPS) for inpatient rehabilitation facilities on reimbursement for traumatic brain injury (TBI) rehabilitation. The new rehabilitation PPS, implemented January 1, 2002, is based on case-mix groups that provide a single payment for all services rendered for individual stays based on the principal rehabilitation diagnosis, functional status, and age. Data were collected from records of patients enrolled in the Traumatic Brain Injury Model Systems from 1998 to 2001, including the cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes. Patients were assigned to their appropriate case-mix group based on the Medicare criteria. Results indicated that the median cost of inpatient rehabilitation for patients with TBI exceeded median PPS payments for all TBI case-mix groups by 16 percent. Authors conclude that the new PPS may reimburse facilities significantly less than their costs for treatment, which may lead to decreased LOSs to compensate for the reductions.
Author(s):
Hoffman, Jeanne M.; Doctor, Jason N.; Chan, Leighton; Whyte, John; Jha, Amit; Dikmen, Sureyya
Author Address(es):

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