Inpatient Hospital-Level Medical Rehabilitation Improves Lives

Inpatient Medical Rehabilitation Hospitals and Units (IRH/Us) are an integral part of the nation’s health care system. They play a crucial role in advancing the care, treatment and recovery of individuals with disabling injuries and illnesses.

What is inpatient hospital-level medical rehabilitation?

Inpatient medical rehabilitation is a unique level of care – a highly specialized, carefully coordinated and individualized program that improves a patient’s function, mobility and independence.  This includes restoring the skills and abilities to perform daily tasks, such as bathing, dressing and eating, as well as speaking, communicating and preparing to return home and to work, school or community activities. In other words, inpatient rehabilitation hospitals and units teams provide treatment that addresses the full range of medical, physical, cognitive, behavioral, social and vocational issues an individual may face as the result of conditions such as stroke, brain and spinal cord injury, neurological diseases, traumatic injuries, burns and other conditions.

What distinguishes an inpatient rehabilitation hospital or unit from other health care settings?

The hallmark of the inpatient rehabilitation hospitals and units is a highly integrated team approach totreatment. The rehabilitation team is led by a physiatrist, a board certified physician who specializes in physical medicine and rehabilitation (PM&R) and includes rehabilitation nurses, physical therapists, occupational therapists, speech language pathologists, psychologists and neuropsychologists, cognitive therapists, social workers/case managers and dietitians, as well as prosthetists, orthotists, recreation therapists and other clinicians.

By tailoring treatment to individual needs and rehabilitation goals, the inpatient rehabilitation hospital teams optimize the abilities, independence and quality of life of each patient.

What is an inpatient rehabilitation hospital or unit?

The Medicare program has regulations which define the hospitals and units for its purposes and refers to them as Inpatient Rehabilitation Facilities (IRFs). The current average length of stay is 13 days.

How Does Medicare Define an Inpatient Rehabilitation Hospital or Unit?

Medicare has specific criteria that a hospital or unit must meet in order to be designated as an Inpatient Rehabilitation Facility (IRF).  These criteria are intended to distinguish IRH/Us from acute care hospitals and other settings, such as nursing homes.  It should also be noted that Medicare reimburses inpatient rehabilitation hospitals and units differently than short-term acute care hospitals. 

Do patients have to meet special criteria to be admitted to an inpatient rehabilitation hospital or unit?

Both Medicare and insurance companies have specific criteria that patients must meet to qualify for this higher level of rehabilitation care. Under Medicare guidelines, in order for a patient to be admitted to a rehabilitation hospital or unit, a rehabilitation physician must certify that the person needs this type of specialized, intensive care.

How are inpatient hospital medical rehabilitation services paid?

Inpatient rehabilitation hospitals and units are paid for the medical rehabilitation services they render by Medicare Part A, commercial insurance, workman’s compensation and other sources. Medicare Part A pays 100 percent of the Medicare-approved amount for a stay in an inpatient rehabilitation hospital or unit for as long as a physician certifies the patient needs this level of care. Medicare pays for approximately 60 percent of all patients treated in inpatient rehabilitation hospitals and units in the United States.

In 2011, more than 371,000 Medicare beneficiaries received care from 1,165 Medicare certified inpatient rehabilitation hospitals or units.  The Medicare reimbursement rate for medical rehabilitation in an inpatient rehabilitation hospital or unit is a set rate per patient.  The average rate is approximately $14,846, depending on the type and severity of the condition, and special characteristics of the hospital.

Medicare spending on inpatient medical rehabilitation represents less than 1.2 percent of total Medicare expenditures.

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