Various kinds of rehabilitation can be provided at home through the Medicare home health benefit, in an out-patient therapy facility, in a skilled nursing facility (SNF), in a comprehensive outpatient rehabilitation facility (CORF), in an inpatient rehabilitation facility (IRF), or in a long-term care hospital (LTCH). A patient's condition and medical needs dictate the setting in which rehabilitation services are provided. The type and amount of care a person receives varies by setting.
A federal standard-the so-called "75 Percent Rule" makes it more difficult for a patient to qualify for an IRF, with the result that more patients lose access to this care and, instead, enter SNFs for rehabilitation. Care in these settings is not the same.
Federal regulations published in 2004 began a three-year phase-in of the requirement that to qualify as an IRF, 75% of the IRF's patients must have one or more of 13 specified conditions and otherwise require intensive rehabilitation services. At present, IRFs are defined as facilities in which 60% of patients have one of the 13 conditions and otherwise require intensive rehabilitation services.
While there is overlap in the Medicare beneficiaries who receive care in IRFs and SNFs, the facilities may serve different populations. A study commissioned by the Medicare Payment Advisory Commission (MedPAC) found that, Compared with IRF patients, SNF patients [with hip or knee replacements] are significantly older, have more comorbidities [such as delirium, congestive heart failure, and dementia] and complications [including postoperative pulmonary compromise, cellulitis or decubitis ulcer, mechanical complications due to device or implant, and iatrogenic complications] and are more likely to be eligible for both Medicare and Medicaid.
The multifaceted nature of these patients calls for a team-oriented approach, and personalized model of care. With a multispecialty approach, with each clinician providing care to these patients, within their medical expertise, a better outcome is achieved. As the healthcare delivery system moves toward value instead of volume, a team approach provides value, in delivering care to these patients. Legacy Physiatry Group can provide in part, by providing physiatry services to those patients in therapy.
When the patients rehabilitation and pain management needs are managed by a physiatrist, a better outcome is noted. Unlike an IRF, SNF rarely had a physiatrist on staff. With more and more patients being discharged to SNF for their rehabilitation needs, due to changes in CMS regulations, Legacy Physiatry Group was created, to find physiatrist, nurse practitioners, and physicians assistance who would be able to assist and manage these patients in a SNF environment.