WASHINGTON, April 23 /PRNewswire/ -- The American Medical Rehabilitation Providers Association (AMRPA), the leading national trade association representing over 450 freestanding rehabilitation hospitals, rehabilitation units of acute care general hospitals and numerous outpatient rehabilitation services providers, criticized the newly released rehab hospital “IRF” report by the Government Accountability Office (GAO). Although the title of the report suggests that GAO recommends revisions to the classification criterion for inpatient rehabilitation facilities (IRFs) under the Medicare program known as the 75% Rule, GAO did not fulfill its congressional mandate and failed to make substantive recommendations to modernize the criteria. The Centers for Medicare and Medicaid Services (CMS) uses several classification criteria, including the “75% Rule,” to determine how to reimburse facilities for treatment and patient care.
“The best things about the GAO Report are the title and its recognition that additional study is warranted -- but everyone knows that CMS needs to refine the classification criteria,” said AMRPA Board Chair and Casa Colina CEO, Dr. Felice Loverso. “Our membership is disappointed that GAO did not directly respond to the mandate from Congress and provide a more substantive assessment of additional services that would be clinically appropriate for treatment in inpatient rehabilitative settings. The GAO’s unwillingness to provide an independent and comprehensive evaluation means access to quality rehabilitative care will continue to be increasingly compromised by CMS’ narrow interpretation of the 75% Rule.”
AMRPA estimates that in the first year alone, hospitals will be forced to deny care to over 39,000 patients in order for the hospitals to maintain compliance with the new 75% Rule. By the fourth year of the 75% Rule, IRFs will be forced to turn away one out of every three patients in order to operate as a rehabilitation hospital or unit.
The GAO report, titled “Medicare: More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities,” came in response to a 2004 request by Congress as part of the Medicare Modernization Act. Congress required GAO to “issue a report, in consultation with experts in the field of physical medicine and rehabilitation to look at whether the current list of conditions represents a clinically appropriate standard for defining IRF services, and, if not, which additional conditions should be added to the list.”
“The primary thing GAO correctly identified was the pivotal role of function in the rehabilitation process and the need to revise the conditions to incorporate functional status. Otherwise, GAO did not come close to providing a substantive examination of the problem nor did it provide any effective solution,” said Dr. Loverso. “AMRPA members hope that CMS will move as quickly as possible to mobilize the expertise necessary to revise the criteria and protect patient access to quality rehabilitative care. In the meantime, AMRPA will continue to try to work with CMS to fully modernize these outdated and obsolete criteria.”
AMRPA expressed additional concern that the GAO Report fell far short on the Congressional directive. “Congress asked GAO to work with experts in the field to evaluate the appropriateness of the classification criteria and make recommendations on conditions to add to the list. Instead, the GAO report tells Congress what the rehabilitative industry already knew -- that the current classification criterion known as the 75% Rule does not adequately help in defining a rehabilitation hospital or unit, as distinct from an acute care hospital,” said Dr. Loverso. “Patients who benefit significantly from inpatient rehabilitative care will continue to be denied access as a result of this failure.”
In addition, Dr. Loverso expressed frustration that the GAO report did not accurately portray IRF compliance activity. “CMS does not realize how deeply the 75% Rule affects Medicare beneficiaries seeking the highest quality care in rehabilitation hospitals and units, and the significant steps the field has taken to comply with the 75% Rule.” The GAO report used newer CMS interpretations of the 75% Rule to gauge IRF compliance activity instead of previous interpretations issued by fiscal intermediaries and CMS, under which many facilities were operating until recently.
“There is significant consensus among rehabilitation professionals for expanding and modernizing the regulation to address cardiac, pulmonary, transplant and other Medicare patients served in rehabilitation hospitals. Yet, the GAO report fails to address this issue except in a subjective, conclusory fashion,” said Dr. Loverso. “The AMRPA Board of Directors urges the Department of Health and Human Services and CMS to take the necessary immediate steps to refine the Rule before proceeding with further implementation or enforcement activities.”
American Medical Rehabilitation Providers Association
CONTACT: Carolyn Zollar, +1-202-223-1920 or Martie Kendrick,+1-202-457-6520, both of The American Medical Rehabilitation ProvidersAssociation
Web site: http://www.amrpa.org/