Medicare Compliance & Reimbursement

Report:  30,000 fewer benes got IRF services in first year.

A report from two hospital organizations warns that the '75-Percent Rule' unfairly reduces patients' access to inpatient rehabilitation facilities for necessary care.

The American Hospital Association and the Federation of American Hospitals released a Moran Company study on Sept. 22 showing that the Centers for Medicare and Medicaid Services underestimated the rule's effects on IRFs.
 
Approximately 30,000 fewer Medicare patients have received services in an IRF in the first year following CMS' implementation of the 75-Percent Rule, while the agency had estimated a decrease of only 1,170 patients, the study finds. Further, the hospital organizations' total estimate for lost IRF patients is 40,000 for 2005.

The groups also doubt the accuracy of the rule's 13 qualifying conditions for patients admitted to IRFs. Under the rule, a facility that wants CMS to classify it as an IRF must prove that "75 percent of its admissions are cases that fall into one of 13 qualifying conditions, most of which were first established 20 years ago," the groups say. "Hospitals and patient groups believe that the conditions are too narrowly drawn and omit many vital and newer rehabilitation services, such as cardiac, transplant and cancer care."

FAH and AHA urge CMS and lawmakers once again to consider existing legislation that would continue the rule at its current level for two additional years.