Advocacy & News

New Research Finds Inpatient Rehabilitation Hospitals Offer Critical Capacity ‎to COVID-19 and non-COVID Patients

(Washington, December 13, 2021) The American Medical Rehabilitation Providers Association (AMRPA) in partnership with ATI Advisory (ATI) released research today highlighting the critical role inpatient rehabilitation hospitals (IRHs) have played and continue to play during the COVID-19 pandemic in admitting and treating complex patients with medical, rehabilitative, and behavioral health needs. AMRPA represents more than 650 inpatient rehabilitation hospitals and rehabilitation units across the United States. ATI is a research and advisory firm working to transform the delivery of healthcare and aging services for the highest-need seniors.

ATI gathered perspectives from short-term acute care hospital (STACH) and IRH clinicians and executives with first-hand knowledge of the provider and payer spectrum to inform this work. ATI also analyzed Medicare Fee-For-Service (FFS) claims during the pandemic to identify patient trends and support qualitative feedback.

The findings show that IRHs adapted their hospitals based on local circumstances, including adjusting their physical footprint and typical admission pathways, and collaborated with STACHs to rapidly admit COVID-19 positive and non-COVID patients. IRHs provide care to complex patients (IRH Case Mix Index, a measure of patient complexity, peaked at 1.50 in April 2020, compared to 1.42 in December 2019) in a safe hospital environment (from March-November 2020, Medicare FFS claims analysis shows the rate of COVID-19 infection acquired in national IRHs remained below 1%).

This work builds on previous ATI research, which focused on Long-Term Acute Care (LTAC) hospitals during the COVID-19 pandemic, and further underscores the importance of a hospital-based asset class that can quickly deliver capacity and share resources efficiently to ensure safe, timely, and equitable health care. Flexibilities, including federal waivers and prior authorization relief, further promoted these fundamentals of post-acute care.

“Federal waivers and prior authorization relief seem to offer a space for quicker clinical decision-making typically obscured by administrative barriers,” noted Conner Esworthy, Advisor at ATI Advisory and research lead. “These flexibilities should remain part of the health system’s public health emergency arsenal to better utilize existing institutional capacity.”

“For much of the past year, ATI has tracked Medicare claims data and spoken with healthcare stakeholders across the country to assess the vital role that inpatient rehabilitation providers have played throughout the COVID-19 public health emergency. As ATI’s final report shows, the physician-led care, clinical competencies, and infection control protocols employed by inpatient rehabilitation hospitals and units made our hospitals uniquely situated to address the critical hospital capacity issues during the pandemic. These are also the same factors that make inpatient rehabilitation a distinct and essential component of the post-acute care continuum outside of a public health emergency. This paper should therefore be a valuable resource to policymakers as the pandemic informs post-acute care reform in the coming years. The COVID-19 pandemic has placed an unparalleled test on the healthcare system, and I am incredibly proud of the way our field has and continues to play a frontline role and capably serve the nation’s most complex patients,” said Anthony Cuzzola, AMRPA Board Chairman.

Insights from the pandemic elucidate the unique role each post-acute care setting plays. This exploration of IRHs’ experience is a resource for IRHs, STACH discharge managers, payers, patients, and their families to help advocate for holistic care that matches patients with the setting where they have the best chance for recovery. As an IRH Vice President of Post-Acute Services and study participant stated, “Everybody has a role. One facility or service is not a panacea. Our job is to determine the intervention that will work best for that population.”

See the full analysis here.

About the American Medical Rehabilitation Providers Association
AMRPA is the nation’s only trade organization dedicated solely to the interests of inpatient rehabilitation and represents more than 650 freestanding rehabilitation hospitals and rehabilitation units of general hospitals. AMRPA member hospitals help their patients maximize their health, functional ability, independence and participation in society so they are able to return to home, work or an active retirement. For more information, visit and follow AMRPA on Twitter, Facebook and LinkedIn.

About ATI Advisory

ATI Advisory is an advisory services and research consulting firm focused on transforming the healthcare delivery and financing systems for frail, older adults. ATI Advisory applies quantitative and qualitive research methods to identify opportunities to improve Medicare, Medicaid, and long-term care, and it stands by research and data as the foundation of quality. Learn more about ATI Advisory’s work here and follow us on LinkedIn and Twitter.

AMRPA Media Contact:
Robin Applebaum
[email protected]