Stroke Rehabilitation

Medicare cuts reduce rehabilitation services

The Balanced Budget Act of 1997 has reduced reimbursement to agencies that provide Medicare services.There were three significant changes that affect individuals needing rehabilitation,especially stroke victims.

Stroke victims are the highest users of Medicare services after they leave the hospital. Hospitals receive about $5,000 to care for a stroke victim. Medicare penalizes the hospital if the individual is released before 4.9 days of stay, to a nursing home, home health agency or rehabilitation. The goal is ensure that hospitals provide appropriate care and do not discharge patients early.

However, hospitals are now finding they are unable to find appropriate community placements. Rehabilitation hospitals are not taking as many Medicare patients because of the low reimbursements and nursing homes are unable to handle the acute level of care that is needed.

If nursing homes are able to provide services, they too, receive a set amount of money to care for an individual needing skilled care. The reimbursement is based upon a functional rating system to determine the level of acuity of the condition. As the individual's condition improves, the amount of reimbursement received by the nursing home decreases. Rates are based upon 1995 costs to provide care.

Home health agencies are also reducing the number of services that are being provided to patients. This is the result of how Medicare reimburses home care.

Agencies are serving more low cost beneficiaries (individuals who only need five or six visits). Individuals who need more visits and care are finding it more difficult to find care, especially if they have chronic, custodial needs that were previously believed to be skilled needs.

Individuals can now receive a maximum of $1500 of service in physicial and speech therapies combined, and $1500 in occupational therapy per provider. This means that if an individual needs thirty or forty therapy visits, they would have to go to at least two and probably three or four different agencies that provide therapy to receive adequate help and rehabilitation (i.e. enough visits). This will be difficult on patients and will most likely cause concerns for continuity of care.

In summary, stroke victims will find it more difficult to obtain rehabilitative services. Patient advocacy will be most important for the stroke victim in getting care and returning to a previous level of functioning.

Eileen Doherty is the Executive Director of Senior Answers and Services and the Colorado Gerontological Society. She has 25 years of experience in clinical practice, education and training, and public policy with seniors. She can be reached at 303-333-3482.