“First, do no harm,” is a core tenant of the Hippocratic Oath taken by medical students who enter the healing profession.
Unfortunately, proposals being considered in Congress would violate that essential ethical principle.
In a misguided, penny-wise-but-pound-foolish effort to reduce Medicare costs, some lawmakers want to cut reimbursements to rehabilitation hospitals — a move that would force many patients who need to recover from strokes, bad car crashes, brain or spinal cord injuries, neurological diseases or other devastating illnesses, into nursing homes. These cuts would prioritize the cost of providing care over the best care, potentially harming patient’s health and their prospects for resuming normal lives.
But no one has to just take my word for how special and unique the care rehabilitation hospitals provide is; because now there is new empirical evidence to prove it. A national study of 200,000 Medicare beneficiaries recently found that rehabilitation hospitals achieve better outcomes in a shorter time than nursing homes that are treating clinically similar patients. Rehabilitation hospital patients also stay out of hospitals, and avoid emergency room visits, more than those treated in nursing homes.
This study — which carefully matched patients with comparable demographics, clinical conditions and comorbidities to ensure an accurate, scientifically-rigorous comparison — found that over a two-year episode of care, rehabilitation hospital patients returned to home on average two weeks sooner than nursing home patients, remained at home nearly two months longer, and lived nearly two months longer.
On the whole, rehabilitation hospital patients were 8 percent more likely to stay alive than nursing home patients over a two-year period. Those with brain injuries and strokes were 16 percent and 14 percent respectively more likely to survive after having been cared for in a rehabilitation hospital. In addition, rehabilitation hospital and unit patients with 7 of the 12 diagnostic conditions showed significantly fewer hospital readmissions and 5 percent fewer emergency room visits per year than those who were treated in nursing homes.
These significantly better clinical outcomes were achieved at an additional cost to Medicare of just $12.59 a day. And the real world difference in costs is much less, since this study did not account for patient-born expenses, such as co-pays and deductibles, physician visit costs, or any Medicaid costs for all those nursing home patients who couldn’t leave and became permanent residents.
Rehabilitation hospitals work thanks to our highly-tailored, individualized team approach to treatment. Under the supervision of a physician specializing in medical rehabilitation, teams can include rehabilitation nurses, physical therapists, occupational therapists, speech language pathologists, psychologists, neuropsychologists, cognitive therapists, social workers and dietitians. Prosthetists, orthotists, recreation therapists and other clinicians can also be involved. Rehabilitation hospitals are the only institutions that bring together such a complete array of skills and specialties.
While nursing homes are important institutions in their own right, their primary purpose is different, and their staffing levels are not the same as those in rehabilitation hospitals. The rehabilitation nursing homes provide is much less structured or regulated, and they are no substitute for inpatient rehabilitation hospitals and units.
Of course, Congress needs to reign in Medicare spending. But the way to do it is by identifying unnecessary and expensive treatments that don’t produce better health outcomes — not by forcing the weakest and most vulnerable patients to receive care in facilities not tailored to meet their rehabilitation needs and where their likelihood of a successful recovery is significantly less.
Ultimately, what’s best for the patient must always come first. The evidence is now incontrovertible — rehabilitation hospitals are what are best for patients who need to regain the skills enabling them to more quickly return to their family and community activities after a devastating illness or injury. The Medicare payment system must not be changed to restrict patients from being able to access one of America’s great health care solutions – rehabilitation hospitals and units. This would be an unacceptable crisis for the 371,000 beneficiaries who are cared for in rehabilitation hospitals each and every year.
Kathrins is vice chairman of the board of the American Medical Rehabilitation Providers Association and president and CEO of Bacharach Institute for Rehabilitation