Hospital industry lobbyists continue to fight the gradual implementation of the so-called 75% rule, but it appears to be a losing battle.
Two influential groupsthe CMS and the Medicare Payment Advisory Commissioncontinue to support the rules implementation and are giving no indications that their positions will change. The next phase of the rule kicks in July 1, when a key financial reimbursement benchmark jumps to 65% from 60%. The number represents the minimum percentage of a hospitals patients that must have one of 13 medical conditions requiring intensive multidisciplinary inpatient rehabilitation. If the percentage is met, the facility would then qualify for higher reimbursement. Eventually the percentage will rise to 75% by July 2008.
But acute-care hospital groups argue that the rule will limit patient access. Our mission is to provide our patients with the best care at the right time and in the most appropriate setting, American Hospital Association President and Chief Executive Officer Richard Umbdenstock said in a written statement. The 75% rule is putting a stranglehold on access to this vital care. Legislation has been introduced in the House and Senate that would essentially freeze the 75% rule at its current threshold, but its unlikely that it will be approved in June.
With MedPACs support, the CMS further updated and advanced 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, or IRFs), which those with lower acuity cases are increasingly being served in settings that are both less intensive and less costly, the CMS said.
In a letter sent to CMS officials, MedPAC said it continues to support the rule, but recommended that the agency review the 13 diagnoses and clinical criteria for rehabilitation patients to better ensure that the right patients get the right care in the right setting.
Since the rule has started to be phased in, MedPAC said that IRF admission practices have changed substantially. In its report to Congress last March, MedPAC cited data that show the number of IRF cases decreased by more than 9% between 2004 and 2005, while over the same period IRFs aggregate case mix increased. This suggests that IRFs were reducing the number of less severe cases, leaving a residually more complex patient population, MedPAC concluded.
Todd Mackenzie, administrator at 122-bed Deer Creek of Wimberley (Texas), said that he wants to see the 75% rule progress as scheduled, both as a businessman and as the leader of a hospital. We provide the same services that a hip-and-knee (patient) would get at an inpatient rehabilitation facility, Mackenzie said. The difference is in the cost. They get reimbursed at $850 a day. Were reimbursed at $350, he said.