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Protect Patient Access to the Right Care Setting, Not the Cheapest | Commentary

“It won’t happen to me.” That’s what we all think when something tragic happens to someone else. Christopher Reeve incurs a spinal cord injury while riding a horse. Congresswoman Giffords sustains a brain injury while campaigning. The Boston Marathon bombing survivors lose limbs, just as our nation’s servicemen and women who fought in Iraq and Afghanistan have.

“It won’t happen to me.”

In the blink of an eye, a car wreck, stroke or devastating illness can rob us of the most basic but essential abilities — walking, bathing, dressing, eating, speaking or even thinking. And while medical advances save lives, it’s the specialized medical rehabilitation provided in a rehabilitation hospital or unit that enables patients to resume their lives, restore their health and regain the skills they need to return home, to work, school or community activities.

Over the years, there has been serious consideration of cutting access to rehabilitation hospitals for Medicare patients. Just last month in its June report to Congress, MedPAC proposed to pay the same amount for rehabilitation regardless of whether the patient is treated in an inpatient rehabilitation hospital or a nursing home. This is referred to as “site-neutral” payment. Their rationale is that the daily cost of care in the nursing home is lower than the hospital, and the care is similar.

In considering the MedPAC report, policy makers must ask what will be the impact and true long-term costs if Medicare patients are diverted away from rehabilitation hospitals and into nursing homes that offer some rehabilitation services for less money. Inpatient rehabilitation hospitals and nursing homes each play an important role for Medicare beneficiaries, but they are simply not the same. They do not offer the same level of rehabilitation care, and patient outcomes are significantly different in both settings. Medicare beneficiaries deserve the level of complex rehabilitation necessary to meet their individual needs and should not be barred from obtaining appropriate rehabilitative care.

Rehabilitation hospitals provide a unique level of care that is specialized, carefully coordinated, intensive, and individualized to help each patient increase their functions, mobility and independence. This makes all the difference in the ability to resume life activities, return to work, live independently, and participate in community activities.

Now, there is new research being released at a briefing hosted by Sens. Tim Johnson and Mark S. Kirk that shows what this difference really means in terms of outcomes.

A national study of 200,000 Medicare beneficiaries 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 general 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 eight 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 five percent fewer hospital readmissions and five percent fewer emergency room visits per year than those who were treated in nursing homes.

These superior clinical outcomes were achieved at an additional cost to Medicare of only $12.59 a day. In fact, timely, intensive and coordinated rehabilitation provided in a rehabilitation hospital or unit decreases unnecessary long-term dependency costs to the federal government. It returns Medicare patients to their homes and communities, and decreases the need to shift costs to the states by relying on Medicaid as the payer of last resort for unnecessary long-term nursing home care. It is also the linchpin to reducing costly and needless hospital readmissions for those with a wide range of debilitating conditions.

Congress should consider this new study when next faced with proposals that would decrease short-term Medicare expenditures by simply shifting costs to patients, states and other provider settings. It should avoid proposals that will lead to a reduction in access to intensive, coordinated rehabilitation services or that create barriers or channel patients into settings that do not meet an individual’s medical and rehabilitation needs. Instead, Congress should ensure that patients get the right treatment in the right setting for the right duration of time.

Achieving significant federal savings on the backs of people with disabilities and some of our most vulnerable Medicare beneficiaries is not the path to success.

Susan Stout is interim president & CEO of the Amputee Coalition, Susan H. Connors is president & CEO of the Brain Injury Association and Alexandra

Bennewith is vice president of government relations, United Spinal Association.

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