Inpatient rehabilitation facilities are a critical venue in the post acute continuum of care. An Inpatient Rehabilitation Facility (IRF) provides specialized services to patients with functional deficits. Patients receiving inpatient rehabilitation usually require 5.5 direct nursing hours per patient per day with an average length of stay of 10-20 days. Inpatient rehabilitation facilities are paid under case mix groups (CMG’s) which are based the resource intensity that would typically be associated with each patient’s clinical condition.
Inpatient rehabilitation providers are also restricted to treating a specific patient population. As one of the special types of hospital excluded from the Medicare Inpatient Prospective Payment System these facilities must admit at least 60% of their patients with certain conditions. Originally referred to as the 75% Rule, under current regulations the percentage has been frozen at 60%.
Conditions included within the percentage rules include the following conditions:
- Spinal Cord Injury
- Congenital Deformity
- Major Multiple Trauma
- Fracture of Femur (Hip Fracture)
- Brain Injury
- Neurological Disorders including multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy, and Parkinson’s disease
- Active polyarticular rheumatoid arthritis, psoriatic arthritis, and seronegative arthropathies resulting in significant functional impairment of ambulation and other activities of daily living.
- Systemic vasculidities with joint inflammation, resulting in significant functional impairment of ambulation and other activities of daily living.
- Severe or advanced osteoarthritis (osteoarthrosis or degenerative joint disease) involving two or more major weight bearing joints (elbow, shoulders, hips, or knees, but not counting a joint with a prosthesis with joint deformity and substantial loss of range of motion, astrophy or muscles surrounding the joint and significant functional impairment of ambulation and other activities of daily living.
- Knee or hip joint replacement (or both), during an acute hospitalization immediately preceding the inpatient rehabilitation stay and also meeting one or more of the following three specific criteria:
- The patient underwent a bilateral hip or knee replacement during an inpatient hospital stay immediately preceding the IRF admission;
- The patient is extremely obese, with a Body Mass Index of at least 50 at the time of admission to the IRF; or
- The patient is age 85 or older at the time of admission to the IRF.
Murer Consultants provides valuable services to new and existing inpatient rehabilitation facilities. For example:
- Murer Consultants can assist clients in the feasibility and development of new inpatient rehabilitation units and hospitals.
- Murer Consultants will serve as liaison between the client and the Centers of Medicare and Medicaid as the facility moves toward Medicare certification.
- Murer Consultants will file all necessary regulatory documentation.
- Murer Consultants will conduct a Mock Survey to determine the client’s readiness for the actual survey process.
- Murer Consultants will assist in identifying means for developing new services and programs targeted to a patient population with specific functional deficits.
- Murer Consultants will review patient discharges to assure compliance with the 60% requirement.
- Murer Consultants will conduct educational work sessions with key medical, clinical and administrative staff to identify areas for program and operational refinement and to identify opportunities for future growth.
To see how Murer Consultants can assist your organization, please contact us.