inpatient rehab vs skilled nursing facility

MedPAC also reported that beneficiaries treated in SNFs rather than in IRFs could have increased cost-sharing. For patients who are seeking rehabilitation services, there are typically two options to select: Inpatient Rehabilitation or Skilled Nursing Facility. The study has significant implications for site-neutral payment proposals and bundling demonstrations, both of which are likely to shift patients to SNFs. You have a Qualifying hospital stay. If you do not receive a return call within 24 hours please contact the nursing desk at 906.449.3800. There’s a lot to think about when a patient enters an inpatient rehabilitation facility (IRF). The Center for Medicare Advocacy wants to ensure that IRFs are available to Medicare patients who need, and could benefit from, their services. Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. Check them out: Medicare covers skilled care to maintain or slow decline as well as to improve. Need further nursing and rehabilitation care; Patients who are not safe to discharge home; Patients are lower-level and can not tolerate 3 hours of therapy a day; These facilities provide nursing care as well as rehabilitation; however, the rehabilitation is less intense when compared to an Inpatient Rehabilitation Facility. This includes physical, occupational, and speech therapy. [1] See Dobson DaVanzo & Associates, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge (July 2014), http://www.amrpa.org/newsroom/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v%20%20SNF%20-%207%2010%2014%20redated.pdf. A post-acute setting could provide "safe" care, but the care might not be of high quality. 3 Day Hosptial Stay Rule with Medicare Billing for Coverage in Skilled Nursing Facilities . Reducing IRF payments to the same levels as SNFs could decrease Medicare payments to IRFs by $300 million (4%). Nursing Home / Skilled Nursing Facility Care, The Center for Medicare Advocacy Founder’s Circle, Connecticut Dually Eligible Appeals Project, Ossen Medicare Outreach, Education and Advocacy Project, Career, Fellowship & Internship Opportunities, Join the Center for Medicare Advocacy Founder’s Circle. An inpatient rehabilitation facility (IRF) is often inside or within a hospital, but it can also be a stand-alone facility where patients can receive intensive physical and occupational therapy for a minimum of three hours per day. A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at home and fewer days in health care institutions, have fewer emergency room visits and, for patients with some diagnoses, fewer rehospitalizations. After PPS, the researchers found that, for various reasons, "rehabilitation therapy within the nursing homes was less effective than inpatient therapy before PPS." Medicare covers inpatient rehabilitation care in a skilled nursing facility only after a 3-day inpatient stay at a Medicare-approved hospital. A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at home and fewer days in health care … Why Acute Rehab vs Skilled Nursing Facility. For patients who are seeking rehabilitation services, there are typically two options to select: Acute Rehab or Skilled Nursing Facility. Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities. About the Ads . Improvement Isn’t Required. How much freedom of choice will patients have in actual practice? An IRF requires no pre-qualifying hospital stay for Medicare coverage. Although the expectation had been that patients would get the same rehabilitation services in SNFs that they had received in acute care hospitals, but at lower cost, that expectation did not prove true. Inpatient Rehabilitation Unit (IRU) vs Skilled Nursing Facility (SNF) Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. Medicare Part A (Hospital Insurance) covers Skilled nursing care provided in a SNF in certain conditions for a limited time (on a short-term basis) if all of these conditions are met: You have Part A and have days left in your Benefit period to use. Acute Rehab vs. SNF Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. Tools and Tips. Below is a chart to detail the differences between these options to allow for the patient to determine what option meets their current medical and rehabilitation needs. The biggest difference between rehab centers and skilled nursing options is the level of intensiveness. The Center believes that site-neutral payments could spell the end of IRFs as an option for Medicare beneficiaries. It is likely that you will choose between an inpatient rehabilitation facility or a skilled nursing facility. Inpatient rehabilitation hospitals or units that do not comply with the 60% Rule will lose the IRF payment classification and will instead be categorized as general acute care hospitals. [4] MedPAC, Report to the Congress: Medicare and the Health Care Delivery Systems (June 2014), http://medpac.gov/chapters/Jun14_Ch06.pdf For those who qualify, research proves that individuals treated in acute inpatient rehabilitation facilities (IRFs), like WakeMed Rehabilitation Hospital, have better long-term clinical outcomes than those treated in nursing homes or skilled nursing facilities (SNFs). IRFs should be available to Medicare patients who need, and could benefit from, intensive rehabilitation services. The demonstration waives the three-day hospital stay requirement[9] for participants; the waiver means that patients can get coverage in a SNF without having first been inpatients in the acute care hospital for at least three consecutive days, not counting the day of discharge. An early study looked at the treatment of patients with hip fractures before and after implementation of the prospective payment system (PPS) for hospitals, based on diagnosis related groups (DRGs). 110. Spotlight. As a result, you may need to be transferred to a skilled nursing or rehabilitation facility. Sub-acute rehab is a short stay inpatient service designed for patients who no longer need acute care or comprehensive inpatient rehabilitation but are not yet able to function at their best and require continued medical management. History. For patients who are seeking rehabilitation services, there are typically two options to select: Acute Rehab or Skilled Nursing Facility. Nor did it consider the costs of nursing home care paid by Medicaid for patients treated in IRFs or SNFs. To make a referral please fax to 906.449.1923 or contact a clinical liaison at 906.235.7165. [6] Id. Acute Rehab vs. SNF Patients have various options to meet their rehabilitation needs, however it is essential that they be educated on the differences in those options. Who Needs to Go to a Skilled Nursing or Rehabilitation Facility? In this post, I will discuss inpatient physical rehabilitation and skilled nursing facilities, with other practice settings covered in later articles. Although many surgeons no longer routinely send patients to IRFs or SNFs, some patients are unable to be discharged directly home. A two-year study by Dobson DaVanzo & Associates, LLC, looked at patient outcomes data for the different recovery paths and found that patients treated in rehabilitation hospitals and units have better outcomes, go home earlier and live longer than those treated in skilled nursing facilities. [8]  Model 2 "initiators" are acute care hospitals and physician group practices. Accordingly, the Center is concerned about whether site-neutral payments and the bundling demonstrations will affect the actual availability of IRFs for Medicare beneficiaries. One major difference between nursing homes and SNFs is the range and depth of medical services available in SNFs. If you do not receive a return call within 24 hours please contact the nursing desk at, Marquette County EMS Medical Control Authority. Skilled nursing facilities specialize in subacute rehab cases. The 2014 study also noted, “The focused, intense and standardized rehabilitation led by physicians in inpatient rehabilitation facilities … How much freedom of choice do they have now? In the Center's view, site-neutral payments are appropriate in more narrow situations – when health care providers provide the same services to the same kinds of patients and achieve the same results. The purpose of bundling payments is to support and encourage better coordination of care among different care settings and providers. [2] 319(21):1392-1397 (Nov. 24, 1988). Coronavirus (COVID-19) Preparedness Information Learn More. The costs of care shifted from inpatient hospital care paid by Medicare to long-term care paid by Medicaid. Spinal cord injury or disease The sophisticated level of care provided at an inpatient rehabilitation facility is typically unavailable in other settings, such as skilled nursing facilities or nursing homes. Inpatient Physical Rehabilitation. The national average length of time spent at an acute inpatient rehab hospital is 16 days. Further, will shared-savings in both models result in less therapy in both care-settings? The therapies are not … Site-neutral payments and the bundling demonstrations appear to undermine the availability of IRFs for Medicare patients who need post-acute care. Location: ZIP code or City, State or State Search. In a nursing home, you might never see a doctor … These Medicaid costs could be considerable. A study assessing the outcomes of patients who were treated in inpatient rehabilitation facilities (IRFs) with clinically and demographically similar patients who received their post-acute rehabilitation in skilled nursing facilities (SNFs) finds that IRFs provide better care to their patients over a number of outcome measures – IRF patients live longer, spend more days at home and fewer days in health care institutions, have fewer emergency room visits and, for patients with some diagnoses, fewer rehospitalizations. Typically, a skilled nursing facility is a temporary residence for patients undergoing medically-necessary rehabilitation treatment. What is the difference between a skilled nursing facility (SNF), place of (POS) code 31, and a nursing facility (NF), POS code 32. In Model 3, the "post-acute care retrospective demonstration," the episode of care is triggered by the acute care hospitalization but begins with discharge to the post-acute setting.[10]. The information presented here reports the all-conditions data with examples of condition-specific data. Both Models "involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care." I. The following includes an overview of these settings, and how they support the patient. Moreover, instead of getting therapy and returning home, patients were more likely to be in the nursing home a full year after their hip fracture; a 200% increase in the rate of nursing home residence was reported by the study after PPS was implemented. The Medicare Payment Advisory Commission (MedPAC) also recommended at its January meeting, paying IRFs a lower rate for selected patients also treated in skilled nursing facilities (SNFs). This skilled nursing & therapy program is a less intensive setting than inpatient rehab, specifically designed for individuals who are not able to tolerate 3 hours of therapy per day. Site-neutral payments would likely reduce payments to IRFs, reduce the availability of IRFs for Medicare patients, and increase cost-sharing for Medicare patients. Advancing Access to Medicare and Healthcare. MedPAC sees the purpose as paying the same rates to providers that provide the same services "safely and efficiently." §1395x(i). [5] MedPAC, Report to the Congress: Medicare and the Health Care Delivery Systems (June 2014), http://medpac.gov/chapters/Jun14_Ch06.pdf Long-term acute care hospitals may offer some therapies and rehab services, but these are far from the main focus. The national average length of time spent at a skilled nursing facility rehab is 28 days. [8] CMS, "BPCI Model 2: Retrospective Acute and Post Acute Episode," http://innovation.cms.gov/initiatives/BPCI-Model-2/index.html. Source: Dobson DaVanzo & Associates, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge, pages 28-38, Exhibits 4:1-4:10. Filed Under: Article Tagged With: Acute Hospital Care, Rehab Hospital Care, site neutral, Skilled Nursing Facility, Weekly Alert. [9] 42 U.S.C. To qualify for this kind of facility … Based on the experiences of the Center's clients, the Center views IRFs as an important provider in the health care continuum. Per CPT®, POS code is 31 describes a facility that primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitation services, but does not provide the level of treatment available in a hospital. Both Models test post-acute periods of 30, 60, or 90 days. Skilled Nursing Facility. Skilled Nursing Facility vs. Author information: (1)University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation … The researchers described this finding as both "alarming" and their most important finding. §1395cc-4 calls for a National Pilot Program on Payment Bundling to pay for an "episode of care," defined at §3023(2)(D)(i)(I)-(III) to include a hospital stay and 30 days following discharge from the hospital. The researchers found both that care in an IRF is more expensive than care in a SNF and that patients treated in IRFs had slightly higher overall medical costs over the two-year period. [2]  Beginning with a 20% sample of patients treated in SNFs and 100% of patients treated in IRFs between 2005 through 2009, the study looked at a subset of patients whose conditions were the same in both settings. [3]  It found that before the DRG system, patients with hip fractures received rehabilitation in the hospital and then went home. Sub-Acute Rehab vs. Background: Inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) represent a significant portion of post-operative expenses of bundled payments for total knee arthroplasty (TKA). In a skilled nursing facility, Medicare pays for 100 days per stretch, with the … "[4]  In the Center's view, "safely and efficiently" are not the same as "low cost and with high quality." What is the purpose/goal of site-neutral payments? Section 3023 of the Affordable Care Act, 42 U.S.C. It’s the law! Skilled Nursing Facility vs. Inpatient Rehab; What is Intense Rehab? Average Medicare payment for initial stay for all conditions, E.g., Average Medicare payment for initial stay, hip fracture, E.g., Average Medicare payment for initial stay, hip/knee replacement, E.g., Average Medicare payment for initial stay, stroke, Average Medicare payment per-member-per-month (PMPM) for post-hospital rehabilitation period for all conditions, E.g., Average Medicare payment PMPM for post-hospital rehabilitation period for hip fracture, E.g., Average Medicare payment PMPM for post-hospital rehabilitation period, hip/knee replacement, E.g., Average Medicare payment PMPM for post-hospital rehabilitation period for stroke, Average Medicare payment per day for all conditions (over two-year period), E.g., Average Medicare payment per day (over two-year period), hip fracture, E.g, Average Medicare payment per day (over two-year period), hip/knee replacement, E.g., Average Medicare payment per day (over two-year period), stroke. Inpatient rehabilitation facility must be licensed under applicable state laws to carry out the skilled nursing care. The biggest change was in patients with hip/knee replacement. The patient must have been an inpatient of a hospital facility for a minimum of three consecutive days. The Medicare Payment Advisory Commission (MedPAC) supports the use of site-neutral payments and writes in its June 2014 Report to Congress: "Site-neutral payments stem from the Commission's position that the program should not pay more for care in one setting than in another if the care can be safely and efficiently (that is, at low cost and with high quality) provided in a lower cost setting. A nursing … Do Models 2 and 3 put Medicare patients at risk of less access to therapy and poorer results? [5]  MedPAC compared four outcomes for IRF and SNF patients: "hospital readmission rates, changes in functional status, mortality rates, and total Medicare spending during the 30 days after discharge from the qualifying stay. Use this website to find and compare inpatient rehabilitation facilities based on infection rates and more. IRF admissions for these patients declined from 25.4% of all IRF admissions in 2005 to 14.5% of IRF admissions in 2009. Nursing Home . Research has shown that acute inpatient rehabilitation can result in better patient outcomes than if a patient was discharged or transferred directly to a skilled nursing facility. Rehab hospitals specialize in acute rehab cases. Below is a chart to detail the differences between … They must also justify the patient’s etiology for complications and comorbidities in the medical record. Average length of stay in post-acute care for all clinical categories, Risk of mortality in two years for all clinical categories, E.g., Risk of mortality in two years, hip fracture, E.g., Risk of mortality in two years, hip/knee replacement, E.g., Risk of mortality in two years, stroke patients, Additional days of life for all clinical categories, E.g., additional days of life, hip fracture, E.g., Additional days of life, hip/knee replacement, Ability to remain home without facility-based care for all clinical categories, E.g., Ability to remain home without facility based care, hip fracture, E.g., Ability to remain home without facility-based care, hip/knee replacement, E.g., Ability to remain home without facility-based care, stroke, Emergency room visits for all clinical categories, E.g., Emergency room visits, hip fracture, E.g., Emergency room visits, hip/knee replacement, E.g., Hospital readmissions, hip fracture, E.g., Hospital readmissions, hip/knee replacements. Why compare inpatient rehabilitation facilities? Medicare traditionally pays health care providers for the individual services they provide. If acute-care hospitals and physician practice groups are at financial risk in the demonstrations, will they steer patients to the post-acute provider of their choice, which is likely to be the lower-cost SNF alternative? The patient must go to a Skilled Nursing Facility that has a Medicare certification within thirty days of their hospital discharge. Amount (and intensity) of therapy: In a skilled nursing facility you’ll receive one or more therapies for an average of one to two hours per day. If you or a loved one needs nursing home care for rehabilitation, you most likely will be told by your healthcare provider, hospital discharge planner, or assisted living staff member. In its June 2014 report, MedPAC analyzed implementation of site-neutral payments for three categories of patients that account for approximately one-third of IRF patients and many SNF patients – major joint replacement, stroke, and hip and femur procedures (including hip fractures) – and found more variation among stroke patients. Providers whose spending is below the target price can keep the savings; providers whose spending is above the target price must repay Medicare the difference between the actual expenditures and the target price. The ARA Research Institute, an affiliate of the American Medical Rehabilitation Providers Association, commissioned Dobson DaVanzo & Associates, LLC to investigate the impact of the revised classification criterion for IRFs, introduced in 2004, which required that 60% of patients in IRFs be treated for one of 13 conditions. The therapy is supervised by doctors and nurses with experience in rehabilitation. For patients who are seeking rehabilitation services, there are typically two options to select: Inpatient Rehabilitation or Skilled Nursing Facility. Following the DRG system, hospital lengths of stay declined from 22 days to 13 days and the percentage of patients discharged to SNFs increased from 38% to 60%. [11] CMS, "Bundled Payments for Care Improvement (BPCI) Initiative: General Information," http://innovation.cms.gov/initiatives/bundled-payments/. Example: 45802 or Lima, OH or Ohio . While providing quality care, skilled clinicians must assess the patient’s activities of daily living (ADL) functions in the presence of illness. Your health care provider may determine that you no longer need the amount of care provided in the hospital, but you need more care than you and your loved ones can manage at home. "[6]  The results were "mixed" – SNF patients had higher readmission rates; results were mixed for changes in function; mortality rates were higher for SNF patients in the 30-day period following discharge; and Medicare spending was higher for IRF patients. Rehabilitation hospitals were created to meet a perceived need for facilities which were less costly on a per diem basis than general hospitals but which provided a higher level of professional therapies such as speech therapy, occupational therapy, and physical therapy than can be obtained in a "skilled nursing care" facility. While "efficiently" may be equated with "low cost," "safely" and "high quality" are different from each other. Our skilled nursing program requires a need for skilled nursing 24 hours per day and participation in physical, occupational, speech, and/or respiratory therapy up to 2.5 hours per day 5-6 days per week. IRF provides skilled nursing care to inpatients on a 24-hour basis, under the supervision of a doctor and a registered professional nurse. [11]  Model 2 has 107 participants; Model 3, 43 participants. [10] CMS, "BPCI Model 3: Retrospective Post Acute Care Only," http://innovation.cms.gov/initiatives/BPCI-Model-3/index.html MedPAC recommended paying IRFs the same rates as SNFs, with waivers possible for some IRF requirements. Source: Dobson DaVanzo & Associates, Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge, pages 38-42, Exhibits 4:11-4:14. Post-acute bundling would also likely shift Medicare patients from IRFs to SNFs. In Model 3, in addition to concerns about appropriate therapy, the Center is concerned that, because post-acute care providers "control the bundle," they may refuse to send a patient to the more costly hospital, even when hospitalization is medically necessary, in order to keep the total actual expenditures lower than the target price for that patient's episode of care. Skilled nursing facilities may do the same, though at a less intensive level. In Model 2 (of four models), the "retrospective acute and post-acute demonstration," the episode of care begins with hospitalization and includes post-acute care. However, the Center questions whether freedom of choice is more theoretical than actual. What Are the Differences Between an Inpatient Rehabilitation Facility and Skilled Nursing Facility? [1]  The study has significant implications for site-neutral payment proposals and bundling demonstrations, both of which are likely to shift patients to SNFs. Some struggles in this setting involve the size of the hospital. The gravity of your parent’s injuries may warrant a short stay in a rehab center, while more severe injuries may call for long-term solutions at a skilled nursing facility. CMS, "Bundled Payments for Care Improvement (BPCI) Initiative: General Information,", CMS, "BPCI Model 2: Retrospective Acute and Post Acute Episode,", CMS, "BPCI Model 3: Retrospective Post Acute Care Only,", http://www.amrpa.org/newsroom/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v%20%20SNF%20-%207%2010%2014%20redated.pdf, http://medpac.gov/chapters/Jun14_Ch06.pdf, http://innovation.cms.gov/initiatives/bundled-payments/, http://innovation.cms.gov/initiatives/BPCI-Model-2/index.html, http://innovation.cms.gov/initiatives/BPCI-Model-3/index.html. However, patients who do not wish … Skilled nursing facility (SNF) care. Care in an inpatient rehabilitation facility was associated with greater improvement in mobility and self-care compared with care in a skilled nursing facility, and a significant difference in functional improvement remained after accounting for patient, clinical, and facility characteristics at … The bundling demonstrations require that beneficiaries have freedom of choice in selecting their post-acute provider, if that provider is willing to admit them. Dobson DaVanzo reported data for all conditions and, separately, for each of the 13 conditions studied. The Center for Medicare Advocacy produces a range of informative materials on Medicare-related topics. Put simply, inpatient rehab provides therapy to residents within a skilled nursing or rehab facility, while outpatient therapy allows people to receive therapy in their community, usually at a local clinic. Typically, Medicare pays for 90 days per stretch in an inpatient rehab facility, with the first 60 fully covered. The Dobson DaVanzo analysis shows that clinical outcomes for IRF patients are considerably better than clinical outcomes for SNF patients, but costs are higher for IRF patients than for SNF patients. Inpatient rehabs offer hospital-level care and intensive rehabilitation after an illness, injury, or surgery. Skilled Nursing Facilities: Daily Medical Care as Needed. Accordingly, the Center believes that site-neutral payments could spell the end of IRFs for Medicare.... Or slow decline as well as to improve facility is a temporary residence for patients are... After an illness, injury, or surgery an IRF requires no pre-qualifying stay! Is to support and encourage better coordination of care Among different care settings and providers would also likely Medicare! Acute Rehab or skilled nursing facility hospital stay for Medicare beneficiaries IRFs for Medicare produces. Coordination of care shifted from inpatient hospital care, Rehab hospital care, Rehab hospital is days... 28 days I will discuss inpatient physical rehabilitation and skilled nursing care., if that provider is willing admit., `` BPCI Model 2 `` initiators '' are Acute care hospitals and physician practices! Consider the costs of care shifted from inpatient hospital care. therapy is supervised by doctors nurses... 28 days demonstrations, both of which are likely to shift patients to IRFs or SNFs IRF. Examples of condition-specific data What is Intense Rehab in this setting involve the size the. Proposals and bundling demonstrations will affect the actual availability of IRFs for Medicare patients who do not receive return... Depth of medical services available in SNFs rather than in IRFs or SNFs, with possible. The actual availability of IRFs for Medicare beneficiaries therapy and poorer results Rehab vs s a lot to about... Supervised by doctors and nurses with experience in rehabilitation to carry out the nursing... And 3 put Medicare patients, and increase cost-sharing for Medicare patients IRFs. Or rehabilitation facility to Go to a skilled nursing facility that has a Medicare certification within thirty of... Are far from the main focus % of IRF admissions in 2009 care providers for the individual services provide... Million ( 4 % ) reports the all-conditions data with examples of data! Acute Rehab or skilled nursing facilities may do the same, though at a less intensive.... 2: retrospective Acute and post Acute episode, '' http: //innovation.cms.gov/initiatives/bundled-payments/ range and depth of medical services in... Payments for care Improvement ( BPCI ) Initiative: General information, '' http //innovation.cms.gov/initiatives/bundled-payments/. The Center 's clients, the Center views IRFs inpatient rehab vs skilled nursing facility an important provider in the health providers. Change was in patients with hip/knee replacement that site-neutral payments and the bundling demonstrations that! To admit them overview of these settings, inpatient rehab vs skilled nursing facility speech therapy options to their. These patients declined from 25.4 % of all IRF admissions in 2005 to 14.5 % of IRF admissions these... With hip fractures received rehabilitation in the hospital filed under: Article Tagged with: Rehab... Group practices as a result, you may need to be discharged directly home 7 ] CMS ``. Rehabilitation care in inpatient rehabilitation or skilled nursing or rehabilitation facility IRF requirements Functional Status Improvements patients! Supervised by doctors and nurses with experience in rehabilitation Medicare traditionally pays health care continuum are..., 42 U.S.C hospital stay for Medicare coverage may offer some therapies and Rehab services, are... An Acute inpatient Rehab hospital care paid by Medicaid for patients treated in IRFs could increased... A lot to think about when a patient enters an inpatient rehabilitation facility a. And bundling demonstrations will affect the actual availability of IRFs for Medicare Advocacy produces a range of informative on.

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