Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy

WHY WE DID THIS STUDY

Inpatient rehabilitation (rehab) hospitals are freestanding facilities that specialize in providing intensive rehab therapy to patients recovering from illness, injury, or surgery. This intensive therapy requires endurance that some patients receiving post-acute care do not have, potentially causing those patients to be better suited for an alternate setting such as a skilled nursing facility. Medicare criteria for admission to post-acute care help ensure that patients receive the most appropriate care for their conditions and needs. In conducting a medical review for a separate evaluation to identify adverse events in inpatient rehab hospitals, physician reviewers found a small number of hospital stays in which the patients appeared to be unsuited for intensive therapy. In response, we extended our medical review to provide additional information about these stays in which patients were unable to actively participate in and benefit significantly from intensive therapy.

HOW WE DID THIS STUDY

We contracted with physicians to review medical records for a sample of patients admitted to inpatient rehab hospitals during March 2012. The physicians identified 39 inpatient rehab hospital stays in which patients were unable to actively participate in and benefit significantly from intensive therapy. For these stays, the physician reviewers identified factors that contributed to the patients' inability to participate and benefit. We also analyzed claims data to determine whether inpatient rehab hospitals kept these unsuitable patients for extended periods of time.

WHAT WE FOUND

We found that patients who were not suited for intensive rehab therapy had physical limitations, lacked endurance, had unresolved health problems, or had an altered mental status. Most of these patients (32 of 39 stays) remained in inpatient rehab hospitals for extended periods of time (which we defined as stays lasting longer than 3 days) despite being unable to participate and benefit from intensive therapy. For 7 of the 39 stays, the medical records indicated that the patients were in exceptionally poor condition and died within a few weeks after being admitted to an inpatient rehab hospital. In all seven cases, patients were unable to participate in intensive therapy and were kept in inpatient rehab hospitals for longer than 3 days.

WHAT WE CONCLUDE

We encourage CMS to consider providing additional technical assistance to ensure that Medicare patients are placed in the most appropriate setting for post-acute care, and that inpatient rehab hospitals do not admit patients who are unable to participate in and benefit from intensive therapy. An OIG audit that is currently in progress will provide a national assessment of the proportion of inpatient rehab stays that do not comply with all Medicare coverage and documentation criteria.