Rehabilitation hospitals fight federal rule

The hospitals and groups that represent them are lobbying for changes in the 75-percent rule. The rule requires that a health care organization that wants to receive Medicare payments as an inpatient-rehabilitation facility must ensure that at least 75 percent of its inpatient population requires care for one or more of 13 conditions. These conditions include stroke, spinal-cord injuries, amputations and brain injuries.

The federal Centers for Medicare and Medicaid Services (CMS) has gradually implemented the rule, and the rule is scheduled to be fully implemented in July. Leaders in the rehabilitation industry are pushing to have the rule’s implementation stopped or rolled back.

Full implementation of the rule will mean that patients who might best be treated in a rehabilitation hospital but do not fall under one of the 13 categories will have to find some other mode of care, opponents to the rule said.

“We have to be much more particular in the patients that we take in,” said Aimee Miller, physician liaison for HealthSouth Rehabilitation Hospital of York in West Manchester Township. “If we are below (a certain percentage), we have to deny people services.”

The rule already has had a significant effect on Miller’s hospital. The facility has cut its number of beds from 102 to 67 so it can better comply with the rule, Miller said. This has led to staff cuts, though Miller did not know how many jobs have been axed.

Health care professionals said they have heard that patients who cannot use rehab facilities are ending up in nursing homes, receiving home-health services or spending more time in acute-care hospitals. It’s unfair that these patients have to receive less-appropriate care solely because of a government rule, said Gene Bianco, president and chief executive officer of the Pennsylvania Association of Rehabilitation Facilities in Lower Paxton Township, Dauphin County.

“They’re not getting as much physical therapy and occupational therapy. And they’re not getting the team approach,” Bianco said. “That’s what’s wacky about this.”

CMS is being strict about how it enforces the rule, said Cheri Rinehart, vice president for integrated-delivery systems at the Hospital & Healthsystem Association of Pennsylvania in Swatara Township, Dauphin County. Facilities that fail to comply with the rule face restrictions on or elimination of their Medicare reimbursements, Rinehart said.

Being cut off from Medicare would mean certain doom for many rehabilitation hospitals, Bianco said. Medicare-age patients account for more than 70 percent of patients who use the hospitals, according to a recently released report from the Pennsylvania Health Care Cost Containment Council in Harrisburg.

Officials with rehabilitation facilities in the midstate said they were uncertain whether legislative action to stop the 75-percent rule would be successful. One good sign is that Pennsylvania’s congressional delegation supports changes to the rule, said Gregory Toot, chief executive officer of HealthSouth Rehabilitation Hospital of Mechanicsburg in Lower Allen Township, Cumberland County.

“I’m cautiously optimistic, but I know it’s an election year, and everybody’s fighting for their own interests,” Toot said. “I think it’s a 50-50 deal right now.”

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For more information about rehabilitation hospitals statewide and how the 75-percent rule is affecting them, check out the Pennsylvania Health Care Cost Containment Council’s annual report on the financial health of non-general-acute care hospitals. The report can be found at www.phc4.org.