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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.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 193 FIGURE 8.2: USA: DECISIONS ON DISCHARGE DESTINATION FROM ACUTE STROKE CARE SERVICES INVOLVE THE CLINICAL EVALUATION 208 AS WELL AS SOCIAL INDICATORS OF THE PATIENTS 209
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Dépôt légal : D/2007/10.273/19
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