PMID- 18996234
OWN - NLM
STAT- MEDLINE
DCOM- 20081202
LR  - 20181201
IS  - 1532-821X (Electronic)
IS  - 0003-9993 (Linking)
VI  - 89
IP  - 11
DP  - 2008 Nov
TI  - Trends in the supply of inpatient rehabilitation facilities services: 1996 to 
      2004.
PG  - 2066-79
LID - 10.1016/j.apmr.2008.05.014 [doi]
AB  - OBJECTIVES: Describe the supply of inpatient rehabilitation facilities (IRFs) 
      services in 1996 and examine changes between 1996 and 2004, including the impact 
      of the IRF prospective payment system (PPS) in 2002 on organizational trends. 
      DESIGN: Retrospective pre-post design. SETTING: Freestanding and subprovider 
      (distinct-part units) IRFs. PARTICIPANTS: IRFs (N=1424), including 257 
      freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report 
      Information System database, from years 1996 to 2004. INTERVENTIONS: Not 
      applicable. MAIN OUTCOME MEASURES: Number of IRF openings, IRF closures, beds, 
      and inpatient days. RESULTS: The number of IRFs grew from 1037 to 1183 between 
      1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF 
      closures trended lower after PPS, and there was a significant increase in the 
      likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs 
      were more likely to open over the entire period. There was a 12.9% increase in 
      the number of total inpatient days, somewhat less than the 15.7% growth in IRF 
      beds over the period. There was no impact of PPS on beds available but a 
      significant decline in total inpatient days after PPS. CONCLUSIONS: Inpatient 
      days rose under the Tax Equity and Fiscal Responsibility Act and declined after 
      2002. Yet the likelihood of openings and closures did not appear to respond to 
      these changes, perhaps because they were modest compared with changes in local 
      IRF markets. The IRF PPS did little to affect service distribution in less 
      well-served areas, although we did find growth in rural areas. Occupancy rates in 
      2004 were close to rates at the start of the period (70%). This observation 
      implies that IRFs were implementing strategies to recruit a sufficient number of 
      patients, even though bed numbers were increasing and length of stay was 
      declining. Consequently, policy that limits the potential of IRFs to increase 
      patient admissions, such as the limits on admissions to IRFs of patients with 
      conditions other than those included in the 75% rule, is likely to produce 
      substantial decreases in total inpatient days.
FAU - Mallinson, Trudy R
AU  - Mallinson TR
AD  - Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, 
      Chicago, IL 60611-2654, USA. trudy@northwestern.edu
FAU - Manheim, Larry M
AU  - Manheim LM
FAU - Almagor, Orit
AU  - Almagor O
FAU - Demark, Holly M
AU  - Demark HM
FAU - Heinemann, Allen W
AU  - Heinemann AW
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arch Phys Med Rehabil
JT  - Archives of physical medicine and rehabilitation
JID - 2985158R
SB  - IM
MH  - Aged
MH  - Cross-Sectional Studies
MH  - Health Facility Closure
MH  - Health Facility Size
MH  - *Health Policy
MH  - *Health Services Accessibility
MH  - Humans
MH  - Length of Stay
MH  - Medicare/economics/legislation & jurisprudence
MH  - *Prospective Payment System
MH  - Regression Analysis
MH  - Rehabilitation Centers/economics/*statistics & numerical data/*supply & 
      distribution/trends
MH  - Retrospective Studies
MH  - Tax Equity and Fiscal Responsibility Act
MH  - United States
EDAT- 2008/11/11 09:00
MHDA- 2008/12/17 09:00
CRDT- 2008/11/11 09:00
PHST- 2008/05/06 00:00 [received]
PHST- 2008/05/08 00:00 [accepted]
PHST- 2008/11/11 09:00 [pubmed]
PHST- 2008/12/17 09:00 [medline]
PHST- 2008/11/11 09:00 [entrez]
AID - S0003-9993(08)00790-9 [pii]
AID - 10.1016/j.apmr.2008.05.014 [doi]
PST - ppublish
SO  - Arch Phys Med Rehabil. 2008 Nov;89(11):2066-79. doi: 10.1016/j.apmr.2008.05.014.