Attending Physician Icahn School of Medicine at Mount Sinai New York, New York, United States
Objectives: This study is designed to explore trends in inpatient rehabilitation facility length of stay (IRF-LOS) and investigate the impact of primary rehabilitation payer on IRF-LOS. This study is primarily exploratory in nature using existing data from the National TBI Model System Database.
Design: This is a retrospective study of 7,079 individuals enrolled in the TBI Model System between 2010-17. The criterion for inclusion was a rehabilitation payer of Medicare, Medicaid, and/or commercial insurance. The criterion for exclusion from the study was a rehabilitation payer of workers’ compensation, private pay, state crippled children’s, no fault insurance, a free bed at the hospital, Medicaid pending, or unknown.
Results: Inpatient rehabilitation facility length of stay declined from 27 days to 23 days between 2010-17. During this period, for patients with Medicare as the primary rehabilitation payer, IRF-LOS increased from 21.3 days to 22.9 days; for those with commercial insurance, it decreased from 28.4 to 23.3 days; and for those with Medicaid, it decreased from 28.7 to 22.8 days. Medicare IRF-LOS showed the least variability with an increase of 7%, whereas commercial insurance IRF-LOS decreased by almost 18% from 2010 to 2017.
Conclusions: The impact of third-party payers, including the Centers for Medicare & Medicaid Services (CMS), should not be understated. These entities aim to decrease overall healthcare costs. At inpatient rehabilitation facilities, this is achieved by decreasing allowable IRF-LOS. The observed shorter IRF-LOS for patients with Medicare as the primary rehabilitation payer may be explained by the Prospective Payment System (PPS), a classification system based on a patient’s diagnosis, impairment, and comorbidities. TBI Model System data does not differentiate between straight and managed Medicare, an area to be further studied that could provide valuable insight. Further studies should also explore the impact of third-party payers on patient access to post-discharge supplies, transportation, and home nursing care.