The report is available in English with a French summary - KCE

192 Musculoskeletal & Neurological Rehabilitation KCE reports 57
• In the US, different facilities provide post-acute care rehabilitation
services: Acute inpatient intensive rehabilitation services; Skilled nursing
units (facility with a subacute unit); Skilled nursing facility (nursing homes);
Inpatient rehabilitation facilities.
• The vast majority of IRF’s are hospital based.
• To qualify as an IRF for Medicare payment, facilities must meet Medicare
conditions of participation for acute care hospitals and some additional
criteria of which the most important is to have a preadmission screening
process to determine that each prospective patient is likely to benefit
significantly from an intensive inpatient rehabilitation program. Medicare
IRF should have no less than 75 percent of all patients admitted with 1 or
more of 13 specified conditions.
• A prospective payment system (PPS) is used to pay for Medicare patient
stays at inpatient rehabilitation facilities. IRFs are compensated for
providing inpatient rehabilitation care based on a pre-determined amount
per case according to the patient’s impairment, age, level of function and
co-morbid conditions. The unit of payment in the IRF PPS is a Medicarecovered
hospital stay (from admission to discharge).
• For skilled nursing services the basic principles of PPS are comparable to
those for IRF.
• The IRF PPS utilizes a patient assessment instrument (IRF PAI), to classify
patients.
• Some initiatives exist on quality measures, but Quality of care in
rehabilitation is not uniformly assessed across the United States and a
variety of measurements is in use.
• The Commission on Accreditation of Rehabilitation Facilities (CARF),
accredits the services of an organization based on preset standards.
8.7.4 Example: Stroke
Accurate information on the current systems in stroke rehabilitation is difficult to
obtain because the different health care providers, private and public, are not equally
sharing their information 205 .
Post-acute care can be provided by home health agencies (HHA), skilled nursing
facilities (SNF), inpatient rehabilitation facilities (IRF) or long-term care hospitals. 206
HHA mainly provides therapy, nursing care and assistance from home health aides 207 .
The main difference between IRF and SNF is the intensity of rehabilitation. Patients are
eligible to be admitted in an IRF if they can sustain 3 hours of therapy while in SNF less
intensive therapy is provided. Long-term care settings are focused on the provision of
nursing care or constant supervision.