Rehab Hospitals Fight Rules Change, Cite Benefits to Recuperating Patients

Andrew Kitchenman | March 17, 2014 | Health Care
Kessler official leads national charge on maintaining funding, but nursing homes support proposed new Medicare guidelines as prudent

Proposed changes to Medicare guidelines could force small rehab hospitals to close their doors, according to its industry association, thus closing off a valuable recuperative resource to patients.

A report produced by the American Medical Rehabilitation Providers Association (AMRPA), says that those who visit inpatient rehab hospitals return home sooner and live longer than similar patients who are treated at nursing homes.

Among those participating in the long-running lobbying effort is Dr. Bruce M. Gans, executive vice president and chief medical officer of the Kessler Institute for Rehabilitation, which has facilities in Chester, Saddle Brook, and West Orange. Gans is the current chairman of AMRPA, an industry trade group for inpatient rehab hospitals.

The report comes at a time when rehab facilities are fighting a pair of federal proposals that would tighten payments to these hospitals. One proposal would increase from 60 percent to 75 percent the minimum number of patients with a set of 13 specified conditions that hospitals must treat to receive Medicare. The other proposal would equalize federal payments between rehab hospitals and nursing homes for certain conditions.

Gans said some smaller rehab hospitals — in New Jersey and elsewhere — depend on offering services to patients with conditions like joint replacements that aren’t on the list of 13 approved therapies. If some rehab hospitals have to cut the number of these patients that they serve to comply with a stricter federal standard, they could close, Gans said.

“It would be a very big problem, because right now the 60 percent standard gives most rehab hospitals sufficient flexibility,” Gans said.

The other proposal — to equalize federal payments for some conditions — has drawn praise from nursing home operators, who see it as a fiscally prudent move. They say that similar services should receive the same payments, regardless of the location where they are delivered. Rehab hospitals currently are paid more than nursing homes.

“When Medicare reimburses different providers at different rates for the same post-acute services, that is not beneficial for the patient nor the taxpayer,” said Mark Parkinson, president and CEO of the nursing home trade association the American Health Care Association, in a statement earlier this month. “A site-neutral payment system would encourage providers to offer higher-quality services in the most effective manner.”

Since 2007, rehab hospitals have had to comply with the 60 percent standard, which requires at least that percentage of hospital patients to have one of the 13 conditions that require more intensive care. These ailments range from stroke and amputation to neurological disorders like multiple sclerosis.

But patients with many conditions that require rehabilitation don’t qualify, including those with cancer, organ transplants, chronic pain, pulmonary conditions, and most joint replacements.

Gans said that if policymakers make this standard stricter by raising the minimum standard to 75 percent, then rehab hospitals would have to turn away patients that have conditions they currently would treat.

“The No. 1 solution is to leave it alone,” Gans said of the AMRPA position. “There’s no problem here.”

The report by consulting firm Dobson DaVanzo & Associates, which was commissioned by the AMRPA, found that over a two-year period, rehab patients returned home from their initial stay two weeks earlier, remained home nearly two months longer and stayed alive nearly two months longer than a similar set of nursing facility patients.