Help Preserve Patient Access to Quality Rehabilitation Care

By

Ken Anthony and Marlene Hughes

As Chief Executive Officers of HealthSouth Rehabilitation Hospitals located in Harmarville and Sewickley, we are deeply worried about a government regulation – known as the 75 Percent Rule – that would negatively impact the unique care and services that inpatient rehabilitation hospitals and units such as ours can provide.

Many patients are not able to return directly home from hospitalization after suffering a serious injury or illness, and inpatient rehabilitation hospitals such as ours provide the essential post-acute care these patients need.

In 2002, the Centers for Medicare and Medicaid Services (CMS) began implementation of what is known as the 75 Percent Rule for inpatient rehabilitation hospitals and units. This means that a percentage of patients, increasing over the next few years up to 75 percent, must be treated for one of 13 specific conditions in order for a hospital to retain its inpatient rehabilitation status.

Essentially, the 75 Percent Rule doesn't account for whole classes of patients, including transplant, cardiac, pulmonary and cancer patients, and many others, whose conditions may not be on the list but who desperately need intensive rehabilitation to get back to their previous levels of independent function.

Like us, administrators across the country are feeling the pressure of operating under a rule that restricts access to a large number of people — desperately in need of care, persons that can be treated but do not fall within a specific category of care. We have been advocating for the past 3 years to assure Medicare patients have access to the highly specialized services they need. If legislation is not acted upon by July 1, 2007, the percentage will rise to 75 percent in 2008, limiting our ability to provide high-quality inpatient rehabilitative care to our community.

Due to these concerns, bipartisan legislation has been introduced in the U.S. House of Representatives and the U.S. Senate.  The legislation, HR1459/S543, the “Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007”, has attracted 123 House and 28 Senate co-sponsors.  In our area Representatives Jason Altmire and Tim Murphy and U.S. Senators Bob Casey, Jr. and Arlen Specter are co-sponsors.  The bills would hold the current 60 percent threshold for compliance and ensure that appropriate medical necessity standards are utilized when evaluating the need for inpatient rehabilitation care.

As Chief Executives, we do not want to face the difficult dilemma of having to tell a patient we cannot provide the care he or she needs.  We do not want to be forced to reduce the numbers of beds and services available and, certainly, we do not want to see HealthSouth Rehabilitation Hospitals and other quality rehabilitation providers close because we could not meet the burdens posed by this regulation.  In addition, this regulation hurts acute care hospitals by reducing the availability of post-acute care. As we are well aware, acute care hospitals in Pennsylvania are already among the most challenged in the nation.

We believe that the “Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007” is the best solution for those of us in the inpatient rehabilitation healthcare community to continue to provide the best available care. For years, doctors have been empowered under Medicare to prescribe these services for seniors, persons with disabilities, and others who need them. This longstanding policy is changing dramatically, potentially harming patients unless Congress takes action immediately. The time is critical; we need action now or Medicare beneficiaries will have reduced access to this highly specialized medical and physical rehabilitative care not available in other settings.

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 Click below to read more about the:

"75% Rule" and "The Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007"