The best way for the federal government to preserve Medicare beneficiary access to quality rehabilitative care is to implement current rules governing that care, according to an alliance of national and regional health care providers.
These rules, often referred to as “the 75 percent rule,” require 75 percent of patients receiving care in inpatient rehabilitation facilities (IRFs) to meet certain diagnosis requirements for the facility to qualify for Medicare payments that are higher than rates paid to hospitals.
“At a time when government officials are struggling to ensure adequate funding for the care and needs of Medicare beneficiaries in all settings, it simply doesn’t make sense to stall implementation of important government rules addressing the appropriate placement of patients needing rehabilitation under Medicare,” said Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care. “It is a fact that skilled nursing facilities (SNFs) are providing high quality rehabilitation care to beneficiaries at dramatically lower costs than IRFs are paid. This is especially true of patients receiving hip and knee replacements.”
New data, issued by the federal Centers for Medicare and Medicaid Services (CMS), support government plans to continue moving toward full implementation of the 75 percent rule. According to CMS, the new data illustrate that “ongoing implementation of the 75 percent rule continues to have the desired effect of ensuring that the most appropriate Medicare beneficiaries have access to care in IRFs, while those with lower acuity cases are increasingly being served in settings that are both less intensive and less costly.”
The report also says that that the categories of patients being directed from IRFs to lower cost settings include those receiving care for lower extremity joint replacement, cardiac rehabilitation, osteoarthritis, and pain syndrome. “These categories are associated with conditions that are not generally considered to require the intensive rehabilitation provided by IRFs and can often be more appropriately cared for in other less intensive settings,” the report said. “SNFs, particularly, are in a better position than ever before to manage patients with musculoskeletal conditions …. [these] are precisely the patients who may need some level of medical monitoring but do not require the intense level of services provided in an IRF setting.”
The 75 percent rule allows Medicare to pay IRFs at their higher payment rates for 25 percent of patients even though those patients do not meet the general criteria for IRF care. IRFs have been successful in lowering the 75 percent threshold to 60 percent in recent years at a high annual cost to the Medicare program.
“The 75 percent rule is responsible public policy,” Rosenbloom said. “In these difficult times, providers must act as responsible stewards of scarce Medicare resources.”
The Alliance is a coalition of national skilled nursing providers that care for approximately 300,000 elderly and disabled patients each day in nearly 1,800 facilities across America. The Alliance is dedicated to improving the quality of skilled nursing care in the United States through measured outcomes and to assuring the government resources necessary to provide high quality care and services.