GANS: Obamacare’s latest casualty: rehabilitative hospitals

Medicare budget cuts would send recuperating patients to nursing homes

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Sometimes the unthinkable happens — a car wreck, a stroke, a devastating illness that leaves one without the ability to perform normal daily tasks like walking, bathing, dressing, eating or even speaking.

After acute-care hospitals save their lives and rebuild their bodies, these patients (including about 371,000 Medicare beneficiaries each year) are transferred to America’s rehabilitation hospitals and units, which serve as a lifeline of treatment and services.

These hospitals help people continue to improve their health, and to recover their ability to function, allowing them to return home and to resume work, school or community activities.

However, President Obama’s budget proposes drastic Medicare regulatory and reimbursement changes being discussed in Congress, putting at risk patient access to this vital network of rehabilitation hospitals and units.

Misguided health-policy experts think that many, if not most, of the patients currently receiving care in rehabilitation hospitals can get the same care for less money by being forced into nursing homes that offer some rehabilitation services.

This is just not true. No one has to just take my word for how special and unique the care rehabilitation hospitals provide is; now, there is new empirical evidence to prove it.

A national study of 200,000 Medicare beneficiaries recently found that rehabilitation hospitals achieve better outcomes in a shorter time than nursing homes that are treating clinically similar patients.

Rehabilitation hospital patients also stay out of hospitals and avoid emergency-room visits more than those treated in nursing homes.

This study, which carefully matched patients with comparable demographics, clinical conditions and co-morbidities to ensure an accurate, scientifically rigorous comparison, found that over a two-year episode of care, rehabilitation hospital patients returned home on average two weeks sooner than nursing home patients, remained at home nearly two months longer, and lived nearly two months longer.

On the whole, rehabilitation hospital patients were 8 percent more likely to stay alive than nursing home patients over a two-year period. Those with brain injuries and strokes were 16 percent and 14 percent, respectively, more likely to survive after having been cared for in a rehabilitation hospital.

In addition, rehabilitation hospital patients had 5 percent fewer hospital readmissions and 5 percent fewer emergency-room visits per year than those who were treated in nursing homes.

These significantly better clinical outcomes were achieved at an additional cost to Medicare of just $12.59 a day per patient. Much more important than cost, though, is the impact on patients’ lives.

As a rehabilitation physician overseeing the care delivered in rehabilitation hospitals, I see our patients experiencing what the data show. For the patients who need our hospitals, no other care can compare to that provided in our hospitals.

Many Americans don’t even know that we have a rich network of rehabilitation hospital beds, some in free-standing hospitals, and many others in specialized units of hospitals that offer short-term acute care. The treatment provided by these rehabilitation hospitals and units is sophisticated, medically overseen and team-based.

Adolescents with spinal-cord injuries, young adults with traumatic brain injuries, and seniors who experience devastating strokes are typical patients who receive intensive rehabilitation therapies, such as physical or occupational therapy, for many hours a day.

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