Article

OBJECTIVE: To determine whether comorbid mental disorders affect inpatient
rehabilitation facility (IRF) costs and to examine the extent to which Medicare's
prospective payment system reimbursement sufficiently covers those costs. DESIGN:
Secondary analysis of Medicare IRF Patient Assessment Instrument files and
Medicare Provider and Review files. Payment was compared with costs for patients
with and without reported mood, major depression, substance use, or anxiety
disorders. The relationships among payment group assignment, comorbidity-related
adjustments in payment, and the presence of mental disorders were estimated.
SETTING: IRFs (N=1334) in the United States. PARTICIPANTS: Medicare
fee-for-service beneficiaries (N=1,146,799) discharged from IRFs from 2002 to
2004. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: IRF costs. RESULTS:
Mental disorders were reported for 13% of the Medicare fee-for-service
beneficiaries. After controlling for payment group and comorbidity
classifications, patients with mood, major depression, or anxiety disorders had
significantly greater costs of $433, $1642, and $247 compared with patients
without these disorders. The higher cost for patients with major depression
(14.9% higher) is sufficient to justify a tier 2 comorbidity classification.
CONCLUSIONS: A reimbursement adjustment for the presence of a major depressive
disorder would bring Medicare reimbursement in line with facility costs. The
failure to compensate facilities directly for providing care to patients with
major depression may result in reduced access to care for these patients. It also
may create a disincentive to meet mental health treatment needs during the
rehabilitative episode. Further work is needed to compare costs between patients
with and without confirmed mental health disorders, given concerns about the
accurate reporting of mental health disorders.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS