Hoffman Jeanne M, Doctor Jason N, Chan Leighton, Whyte John, Jha Amit, Dikmen Sureyya
Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
Arch Phys Med Rehabil. 2003 Aug;84(8):1165-72. doi: 10.1016/s0003-9993(03)00232-6.
To evaluate the potential impact of the new Medicare prospective payment system (PPS) on traumatic brain injury (TBI) rehabilitation.
Retrospective cohort study of patients with TBI. Patients were assigned to their appropriate case-mix group (CMG) based on Medicare criteria.
Fourteen urban rehabilitation facilities throughout the United States.
Patients with TBI admitted to inpatient rehabilitation and enrolled in the Traumatic Brain Injury Model Systems from 1998 to 2001 (N=1807).
Not applicable.
Cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes.
The median cost of inpatient rehabilitation for patients with TBI exceeded median PPS payments for all TBI CMGs by 16%. Only 3 of the 14 hospitals received reimbursement under PPS that exceeded costs for their TBI patients.
Compared with current costs, the new Medicare payment system may reimburse facilities significantly less than their costs for the treatment of TBI. To maintain their current financial status, facilities may have to reduce LOS and/or reduce resource use. With a decreased LOS, inpatient rehabilitation services will have to improve FIM efficiency or discharge patients with lower discharge FIM scores.
评估新的医疗保险前瞻性支付系统（PPS）对创伤性脑损伤（TBI）康复的潜在影响。
对TBI患者进行回顾性队列研究。根据医疗保险标准将患者分配到相应的病例组合组（CMG）。
美国各地的14家城市康复机构。
1998年至2001年入住住院康复机构并纳入创伤性脑损伤模型系统的TBI患者（N = 1807）。
不适用。
住院康复费用、住院时间（LOS）和功能结局。
TBI患者的住院康复费用中位数比所有TBI病例组合组的PPS支付中位数高出16%。14家医院中只有3家根据PPS获得的报销超过了其TBI患者的费用。
与当前成本相比，新的医疗保险支付系统可能会使医疗机构获得的报销金额显著低于其治疗TBI的成本。为维持当前财务状况，医疗机构可能不得不缩短住院时间和/或减少资源使用。随着住院时间缩短，住院康复服务将不得不提高功能独立性测量（FIM）效率或让出院时FIM评分较低的患者出院。
