Potential impact of the new medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation.

OBJECTIVE

To evaluate the potential impact of the new Medicare prospective payment system (PPS) on traumatic brain injury (TBI) rehabilitation.

DESIGN

Retrospective cohort study of patients with TBI. Patients were assigned to their appropriate case-mix group (CMG) based on Medicare criteria.

SETTING

Fourteen urban rehabilitation facilities throughout the United States.

PARTICIPANTS

Patients with TBI admitted to inpatient rehabilitation and enrolled in the Traumatic Brain Injury Model Systems from 1998 to 2001 (N=1807).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Cost of inpatient rehabilitation admission, length of stay (LOS), and functional outcomes.

RESULTS

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.

CONCLUSIONS

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.