Advocacy & News

The Role of IRH/Us During COVID-19 PHE

The Role of IRH/Us During the COVID-19 Public Health Emergency

The American Medical Rehabilitation Providers Association (AMRPA) in partnership with ATI Advisory (ATI) released research 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.

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The COVID-19 pandemic has made evident the distinct role that post-acute care settings1 play within our nation’s healthcare system, and has underscored opportunities to more effectively use these settings for patient care. The way in which the different areas of post-acute care have each managed the pandemic provides new insights regarding their respective capabilities, the implications of which our public health system must consider for future preparedness: not just for pandemics, but for the growing number of Medicare-eligible beneficiaries (10,000 people turning 65 every dayi ) who are increasingly living longer, with more complex care needs.

The need for hospital and institution-based post-acute care capacity – that can keep patients safe from infections – has become even more apparent since the start of the public health emergency. Short-term acute care hospitals (STACHs), which typically discharge more than 40% of Medicare FFS patients to post-acute careii, have faced enormous pressures in managing not only patient volume during COVID-19 surges, but an overall increasingly more complex population. This more acute patient mix has renewed demand for multispecialty post-acute care regimens that integrate medical, rehabilitative, and behavioral care. Long-Term Acute Care (LTAC) hospitals and Inpatient Rehabilitation Hospitals (IRHs)2, as well as Skilled Nursing Facilities (SNFs), all offer these capabilities, but in varying degrees. The pandemic has presented an opportunity to investigate how the differences among these post-acute care settings influenced their respective roles during the public health emergency.


1. Post-acute care includes long-term acute care (LTAC) hospitals which provide hospital-level care for medically complex patients; inpatient rehabilitation hospitals and inpatient rehabilitation units (collectively referred to as IRHs herein) which provide hospital-level intense medical rehabilitation focused on restoring functional independence for individuals with disabilities resulting from an injury, illness or medical condition; skilled nursing facilities (SNFs) which provide skilled nursing, medical management and therapy services to individuals; and home health agencies (HHAs) which provide skilled care delivered by health care professionals in the patient’s home for the treatment of a medical condition, illness or disability. Together these settings are typically referred to as the post-acute care continuum.

2. The term Inpatient Rehabilitation Facility (IRF) is a Medicare construct that includes inpatient rehabilitation hospitals and units. The Social Security Act collectively refers to inpatient rehabilitation hospitals and units as rehabilitation facilities and CMS has also historically legislatively referred to inpatient rehabilitation facilities or “IRFs”. We have chosen to refer to inpatient rehabilitation settings (including hospitals and units) within this paper as IRHs as they are licensed hospitals and not facilities.

Posted: December 13, 2021