Article

OBJECTIVE: To estimate the proportion of patients with ischemic stroke who fall
within and above the total outpatient rehabilitation caps before and after the
Balanced Budget Act of 1997 took effect; and to estimate the cost of poststroke
outpatient rehabilitation cost and resource utilization in these patients before
and after the implementation of the caps. DESIGN:
Retrospective cohort study.
SETTING: Medicare reimbursement system. PARTICIPANTS: Medicare beneficiaries from
the state of South Carolina: the 1997 stroke cohort sample (N=2667) and the 2004
stroke cohort sample (N=2679). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Proportion of beneficiaries with bills within and above the cap before
and after the cap was enacted, and total estimated 1-year rehabilitation Medicare
payments before and after the cap. RESULTS: The proportion of patients with
stroke exceeding the cap in 2004 after the Balanced Budget Act of 1997 was
enacted was significantly lower (5.8%) than those in 1997 (9.5%) had there been a
cap at that time (P=.004). However, when the proportion of individuals exceeding
the cap among both the outpatient provider and facility files was examined, there
was a greater proportion of patients with stroke in 2004 (64.6%) than in 1997
(31.9%) who exceeded the cap (P<.0001). The estimated average 1-year Medicare
payments for rehabilitation services, when examining only the Part B outpatient
provider bills, did not differ between the cohorts (P=.12), and in fact,
decreased slightly from $1052 in 1997 to $833 in 2004. However, when examining
rehabilitation costs using all available outpatient Medicare bills, the average
estimated payments greatly increased (P<.0001) from $5691 in 1997 to $9606 in
2004. CONCLUSIONS: These findings suggest that billing practices may have changed
after outpatient rehabilitation services caps were enacted by the Balanced Budget
Act of 1997. Rehabilitation services billing may have shifted from Part B
provider bills to being more frequently included in facility charges.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS