Article

Objectives: To estimate the difference between cost and
prospective payment system (PPS) reimbursements for rehabilitation
care and to simulate potential consequences of costreducing
strategies.
Design: A retrospective study to estimate costs and functional
status at discharge from care.
Setting: An academic, urban, rehabilitation hospital.
Participants: Stroke patients on their first admission to a
rehabilitation hospital between 1994 and 1998.
Interventions: Not applicable.
Main Outcome Measures: Cost was estimated from billing
databases. Function was measured using the motor and cognitive
components of the FIM instrument.
Results: PPS reimbursements were $10,825 (37%) lower
than costs. No matter how much therapy was reduced, the costs
were still greater than the mean PPS reimbursement. A reduction
in length of stay by 9.6 days was required to bring costs in
line with the PPS reimbursement, reducing discharge cognitive
function by 1.1 points (P
.01). Use of group therapy brought
costs close to PPS reimbursement amount and improved discharge
cognitive function by 0.5 points (P
.10).
Conclusions: Our study shows the large difference between
costs and expected PPS reimbursements that would have been
observed before the PPS. Institutions have many options that
reduce costs, with little effect on function at discharge. Future
studies should determine the impact of evolving reimbursement
rules on facilities' financial status, and on patient outcomes.

Langue : ANGLAIS