Association between 2010 medicare reform and inpatient rehabilitation access in people with intracerebral hemorrhage

Nneka L. Ifejika, Farhaan S. Vahidy, Mathew Reeves, Ying Xian, Li Liang, Roland Matsouaka, Gregg C. Fonarow, James C. Grotta

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. METHODS AND RESULTS: Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95–1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89–0.96), Western states (aOR, 0.89; 95% CI, 0.84–0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86–0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11–1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. CONCLUSIONS: The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.

Original languageEnglish (US)
Article numbere020528
Pages (from-to)e020528
JournalJournal of the American Heart Association
Issue number16
StatePublished - Aug 17 2021


  • Healthcare policy
  • Inpatient rehabilitation facility
  • Intracerebral hemorrhage
  • Medicare
  • Outcome
  • Rehabilitation
  • Skilled nursing facility
  • Patient Discharge/economics
  • United States
  • Humans
  • Middle Aged
  • Male
  • Cerebral Hemorrhage/rehabilitation
  • Health Services Accessibility/trends
  • Inpatients
  • Time Factors
  • Aged, 80 and over
  • Adult
  • Female
  • Registries
  • Medicare/economics
  • Health Care Reform/economics
  • Skilled Nursing Facilities/economics
  • Treatment Outcome
  • Prospective Payment System/economics
  • Outcome and Process Assessment, Health Care/economics
  • Policy Making
  • Rehabilitation Centers/economics
  • Aged

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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