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Medicare coverage associated with increase in rehabilitation access
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Results recently published in the Annals of Surgery showed Medicare coverage was linked with a significant gain in access to rehabilitation services for trauma patients.
Using the 2007 to 2012 National Trauma Data Bank, researchers extracted data on 305,198 patients aged 54 years to 75 years. The investigators assessed data for changes in uninsured rates and associated changes in post-discharge rehabilitation among patients 64 years of age vs. 65 years of age through regression discontinuity models.
Overall, results showed discharge to rehabilitation among 40.1% of patients. Researchers found an abrupt 6.4 percentage-point decline in the number of individuals who were uninsured, as well as a 9.6 percentage-point increase in rehabilitation associated with Medicare eligibility at age 64 years vs. 65 years. Use of skilled nursing facilities guided differences, which were greatest among patients with less-severe clinical presentations, according to results. Abrupt gains in both skilled nursing facilities and inpatient care were demonstrated by Medicare-payment eligibility to patients with a length of stay of 3 days or more and for patients with one or more presumptive diagnosis codes, researchers noted.
Adil H. Haider
“A single birthday should not be the difference between getting good rehab care or not,” Adil H. Haider, MD, MPH, FACS, Kessler Director of the Center for Surgery and Public Health at Brigham and Women’s Hospital, told Healio.com/Orthopedics. “This study found that an additional one in every 10 patients was able to access rehab after turning 65 [years old] and becoming eligible for Medicare. For some patients, this one birthday could mean the difference between life and death.” – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopJ. Tracy Watson, MD
This should come as no surprise to those of us who practice in large urban trauma centers and who care for a large volume of resource-poor patients. It is a common occurrence that outpatient physical therapy and/or inpatient rehabilitation services are routinely denied because of “insurance status” or lack thereof. That orthopedic trauma patients have better functional and long-term outcomes when they participate in organized rehabilitation programs is well documented in the literature and by our own experiences.
The problem is even more apparent for the vast majority of Obamacare recipients. These are usually Medicaid based, and coverage for rehabilitation services is limited or nonexistent. Unfortunately, these cover a younger patient population and in most instances, a population that is generally less healthy than those with other health plans. Thus, the access for rehab services for a large portion of our trauma patient population is significantly reduced, and the implications for our surgical outcomes are obvious.
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