Article

Acute inpatient rehabilitation is often used by cancer patients to
assist with discharge home and/or preparation for further treatment. Private
insurance patients often require approval before transfer to acute inpatient
rehabilitation. OBJECTIVE: To analyze the approval rate of private insurance
carriers for acute inpatient cancer rehabilitation.
DESIGN: Retrospective
analysis. SETTING: Tertiary referral-based cancer center. PATIENTS: A total of 96
consecutive patients with private insurance who had acute inpatient
rehabilitation authorization requests made between April 1, 2014, and September
17, 2014. INTERVENTION: Patient cases were assessed by a physiatrist, deemed
clinically appropriate for acute inpatient rehabilitation, and submitted to
private insurance payers for an approval request. RESULTS: In all, 84 of 96
requests (87%) for private insurance authorization for inpatient rehabilitation
transfer were approved. Of the 96 cases, 14 cases (14.6%) were initially denied.
Nine of 96 (9.4%) progressed to a peer-to-peer appeal, of which only 2 of 9
(11.1%) resulted in approval for inpatient rehabilitation transfer (P = .222).
The insurance carriers represented were designated as insurance A (46 patients,
48%), insurance B (18 patients, 19%), insurance C (12 patients, 13%), and other
insurances (20, 21%). Two of 46 insurance A requests were initially denied, as
compared to 7 of 18 for insurance B, 0 of 12 for insurance C, and 4 of 20 for
other insurances (P = .001). Patients with insurance B (P = .002, odds ratio =
14) and other insurances (P = .062, odds ratio = 5.50) were more likely to be
denied inpatient rehabilitation approval compared to patients with insurance A.
No significant difference between mean Functional Independence Measure scores for
approved and denied patients were found for transfers (P = .239) and mobility (P
= .129), respectively. CONCLUSION: Access to acute inpatient rehabilitation is
unfortunately limited by insurers rather than clinical indicators. Future
multicenter studies and universally accepted guidelines regarding inpatient
rehabilitation criteria are needed.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS