Hospital groups today restated their support for federal legislation that would prevent further implementation of the so-called 75% rule regarding inpatient rehabilitation, while the CMS and long-term-care associations said the regulation is working and needs to progress as initially planned.
Richard Umbdenstock, president of the American Hospital Association, said that the rule restricts access to inpatient rehabilitation for patients who need it in specialized settings. Our mission is to provide our patients with the best care at the right time and in the most appropriate setting, he said. The 75% rule is putting a stranglehold on access to this vital care, making it more difficult for frail, elderly patients to get the services they need. Legislation has been introduced in the House and Senate that would basically freeze the 75% rule at its current threshold of 60%.
Under the regulation, 75% of a hospitals admissions in a given year must come from at least one of 13 diagnoses in order to receive higher reimbursement rates for rehab services. The percentage, currently at 60%, will increase to 65% on July 1, and then top out at 75% in July 2008.
The CMS last week released a report to Congress that updated and further explained its position on the rule. The new data illustrate that the ongoing implementation of the 75% rule continues to have the desired effect of ensuring that the most appropriate Medicare beneficiaries have access to care in (inpatient rehabilitation facilities), while those with lower acuity cases are increasingly being served in settings that are both less intensive and less costly, the CMS stated.
Bruce Yarwood, president and CEO of the American Health Care Association, said he agrees. Efforts now under way in Congress to stop or slow this pro-patient, pro-taxpayer statute would turn back the clock on necessary efforts to transform the U.S. healthcare culture towards one that provides seniors quality care at the lowest, most cost-effective rate, he said in a written statement. -- by Matthew DoBias