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Measuring function for Medicare inpatient rehabilitation payment.

Carter GM, Relles DA, Ridgeway GK, Rimes CM - Health Care Financ Rev (2003)

Bottom Line: However, two items are not associated with cost in the expected way.The probable causes of these anomalies are discussed along with implications for payment policy.We present the rules used to construct administratively simple, homogeneous, resource use groups that provide reasonable incentives for access and quality care and that determine payments under the new IRF prospective payment system (PPS).

View Article: PubMed Central - PubMed

Affiliation: grace_carter@rand.org

ABSTRACT
We studied 186,766 Medicare discharges to the community in 1999 from 694 inpatient rehabilitation facilities (IRF). Statistical models were used to examine the relationship of functional items and scales to accounting cost within impairment categories. For most items, more independence leads to lower costs. However, two items are not associated with cost in the expected way. The probable causes of these anomalies are discussed along with implications for payment policy. We present the rules used to construct administratively simple, homogeneous, resource use groups that provide reasonable incentives for access and quality care and that determine payments under the new IRF prospective payment system (PPS).

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Motor Score Component of the Generalized Additive Model Fit for Stroke and Lower Extremity Joint Replacement: 1999
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Related In: Results  -  Collection


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f3-hcfr-24-3-025: Motor Score Component of the Generalized Additive Model Fit for Stroke and Lower Extremity Joint Replacement: 1999

Mentions: We found that cost declines smoothly with increases in function as measured by the modified motor score in each of the large RICs (and throughout most of the range in all RICs). Figure 3 uses the two largest RICs to illustrate our results. The motor effects are large and sloping in the expected direction (larger scores yield lower costs). The total decline in cost throughout the range of motor scores is slightly higher in stroke than in joint replacement. In each RIC, there is an area of low motor function where the decline in costs is modest, but the decrease in cost with each unit increase in independence accelerates and becomes substantial. For example, at the median motor score in stroke (42), a 1-point increase in independence is associated with a 3.3-percent decrease in costs (after controlling for age and cognitive score). There is also a region at the upper motor score where the rate of decline in costs with increasing motor score slows substantially.


Measuring function for Medicare inpatient rehabilitation payment.

Carter GM, Relles DA, Ridgeway GK, Rimes CM - Health Care Financ Rev (2003)

Motor Score Component of the Generalized Additive Model Fit for Stroke and Lower Extremity Joint Replacement: 1999
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4194823&req=5

f3-hcfr-24-3-025: Motor Score Component of the Generalized Additive Model Fit for Stroke and Lower Extremity Joint Replacement: 1999
Mentions: We found that cost declines smoothly with increases in function as measured by the modified motor score in each of the large RICs (and throughout most of the range in all RICs). Figure 3 uses the two largest RICs to illustrate our results. The motor effects are large and sloping in the expected direction (larger scores yield lower costs). The total decline in cost throughout the range of motor scores is slightly higher in stroke than in joint replacement. In each RIC, there is an area of low motor function where the decline in costs is modest, but the decrease in cost with each unit increase in independence accelerates and becomes substantial. For example, at the median motor score in stroke (42), a 1-point increase in independence is associated with a 3.3-percent decrease in costs (after controlling for age and cognitive score). There is also a region at the upper motor score where the rate of decline in costs with increasing motor score slows substantially.

Bottom Line: However, two items are not associated with cost in the expected way.The probable causes of these anomalies are discussed along with implications for payment policy.We present the rules used to construct administratively simple, homogeneous, resource use groups that provide reasonable incentives for access and quality care and that determine payments under the new IRF prospective payment system (PPS).

View Article: PubMed Central - PubMed

Affiliation: grace_carter@rand.org

ABSTRACT
We studied 186,766 Medicare discharges to the community in 1999 from 694 inpatient rehabilitation facilities (IRF). Statistical models were used to examine the relationship of functional items and scales to accounting cost within impairment categories. For most items, more independence leads to lower costs. However, two items are not associated with cost in the expected way. The probable causes of these anomalies are discussed along with implications for payment policy. We present the rules used to construct administratively simple, homogeneous, resource use groups that provide reasonable incentives for access and quality care and that determine payments under the new IRF prospective payment system (PPS).

Show MeSH
Related in: MedlinePlus