Amputees treated in inpatient rehabilitation facilities experienced better long-term clinical outcomes compared with amputees who were treated in skilled nursing facilities, according to a recent report conducted by Dobson DaVanzo & Associates LLC.
“There is a difference in the intensity and the specificity of the services provided,” Terrence P. Sheehan, MD, medical director for the Amputee Coalition, told O&P Business News. “The amount of service that [a patient receives] is different and there is a question of whether this could be because the expense is different. Through the study, the researchers wanted to decide if the care and the outcomes were the same. We wanted to find out whether somebody who went to a skilled nursing facility for rehabilitation after limb loss would have the same outcome as someone who went to an acute rehab program at an inpatient rehabilitation facility.”
IRFs vs. SNFs
Researchers analyzed all Medicare Part A and B claims across all care settings using a 20% sample of Medicare beneficiaries augmented with a 100% sample of inpatient rehabilitation facility (IRF) and long-term care hospital beneficiaries from 2005 through 2009, excluding physicians and durable medical equipment. Patient episodes were created for the longitudinal analysis to track all Medicare services and payments following discharge from a post-acute rehabilitation stay in an IRF and a skilled nursing facility (SNF). Using a one-to-one propensity score match, the researchers matched patients admitted to a SNF following an acute care hospital stay to clinically and demographically similar IRF patients. Following discharge from the rehabilitation stay, patient outcomes were tracked for 2 years.
Study results showed a decrease in lower extremity major joint replacement patients treated in IRFs from 25.4% in 2005 to 14.5% in 2009, a trend that continued through 2013, according to the Medicare Payment Advisory Commission. During the same time period, there was an increase in the proportion of patients treated for hip and knee replacements in SNFs.
Following the implementation of the revised 60 Percent Rule, the longitudinal analysis showed better long-term clinical outcomes for patients treated in IRFs vs. SNFs, according to study results. Researchers also found patients treated in an IRFs who were clinically comparable to patients treated in SNFs returned home from their initial stay 2 weeks earlier. They remained home nearly 2 months longer and stayed alive nearly 2 months longer. During the 2-year study period, researchers found IRF patients had an 8% point lower mortality rate and 5% fewer emergency room visits per year vs. SNF patients. Patients from IRFs also experienced significantly fewer hospital readmissions for 5 of the 13 conditions per year vs. SNF patients. Overall, the additional cost to Medicare for treating patients in an IRF would be $12.59 per day.
“As this study shows, the timely, intensive and coordinated services provided in a rehabilitation hospital or unit help those with limb loss return to their homes and communities faster than skilled nursing facilities,” Susan Stout, interim president and CEO of the Amputee Coalition, stated in a press release. “Policymakers and regulators should consider this study as they make future decisions that could impact where those with limb loss receive care. Decisions should not be made based on short-term cost, but on where patients can most quickly improve their health and regain the functional skills they need to return home, to work, school or community activities.”
Saving time, money
After someone undergoes an amputation, they are dependent on their health care provider to determine what the next steps are. According to Sheehan, the results of this study should help guide practitioners in where to send patients after their procedure.
“What I am hoping is that this study, because it is a landmark study, is not only getting out to those who experienced limb loss, but also the health care providers who will then know with clarity where someone should start their rehab process after they lose a limb,” Sheehan said.
Another place this study will make an impact is deciding on where to spend health care dollars in the future.
“As health care dollars are limited and are going to be more limited in the future it is going to be important when people are making decisions on where to spend those dollars,” Sheehan said. “[This study] is important moving forward because without it patients may not get the services they need because people don’t want to spend the money.” — by Casey Tingle
DaVanzo JE. Assessment of Patient Outcome of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge. Available at: www.amrpa.org/newsroom/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v%20%20SNF%20-%207%2010%2014%20redated.pdf. Accessed August 6, 2014.
Disclosure: Sheehan has no relevant financial disclosures.