The unmet need for postacute rehabilitation among medicare observation patients: A single-center study
BACKGROUND
Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs.
OBJECTIVE
To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization.
DESIGN/SETTING
Observational study using electronic medical record and administrative data from a regional health system.
PATIENTS
1323 community-dwelling Medicare patients admitted under observation status.
MEASUREMENTS
Summary statistics were calculated for demographic and administrative variables. Physical therapy (PT) and case management recommendations for a representative sample of 386 medical records were reviewed regarding need for PAIR services. Linear regression was used to measure the association between PT recommendation and hospital length of stay, adjusting for ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis, age, sex, and provider. Chi-square test was used to determine the association between PT recommendation and 30-day hospital revisit.
RESULTS
Of the 1323 study patients, 11 (0.83%) were discharged to PAIR facilities. However, 17 (4.4%) of the 386 patients whose charts were reviewed received a recommendation for this care. Adjusted mean hospital stay was longer (P < 0.001) for patients recommended for rehabilitation (75.9 h) than for patients with no PT needs (46.8 h). In addition, the 30-day hospital revisit rate was higher (P = 0.037) for the patients who had been recommended for rehabilitation (52.9%, 9/17) than for those who had not (25.4%, 30/118).
CONCLUSIONS
Medicare observation patients’ potential need for PAIR services is 5- to 6-fold higher than their use of these services. Observation patients recommended for this care may have worse outcomes. Journal of Hospital Medicine 2017;12:168-172. © 2017 Society of Hospital Medicine.
© 2017 Society of Hospital Medicine
CONCLUSION
As our study results suggest, there is an unmet need for PAIR services for Medicare observation patients, and LOS and subsequent use may be increased among patients recommended for PAIR. Our estimates are conservative and may underestimate the true need for services within this population. Our findings bolster MedPAC recommendations to amend the policies for Medicare coverage of PAIR services for observation patients.
Acknowledgment
The authors thank Paul Kolm, PhD, for statistical support.
Disclosures
Dr. Schwartz reports receiving personal fees from the Agency for Health Research and Quality, Bayer, the Blue Cross Blue Shield Association, Pfizer, and Takeda, all outside the submitted work. Dr. Hicks is supported by an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health (grant U54-GM104941; principal investigator Stuart Binder-Macleod, PT, PhD, FAPTA). The other authors have nothing to report.
