GAO recommends more specific criteria for IRF classification

Healthcare Financial Management, June, 2005

Greater clarity is needed about what type of patients should receive the intensive level of services provided in inpatient rehabilitation facilities, according to a GAO report released in late April. In FY03, only 6 percent of IRFs were able to meet a 75 percent threshold of required levels of services; fewer than half of all IRF Medicare patients were admitted with conditions listed in the 75 percent rule. Further, nearly half of the patients admitted for conditions not on the list had orthopedic conditions, and of those patients, the majority required joint replacements that did not meet the list's criteria. Very few of these patients had comorbid conditions requiring a need for IRF care.

To help ensure that IRFs are classified appropriately and that only patients requiring IRF services are admitted, GAO recommends that the Centers for Medicare and Medicaid Services provide a thorough description of the subgroups of patients within a condition that require IRF services, encourage research on the effectiveness of intensive IRF care, and ensure routine review of IRF admissions for medical necessity.

To download the GAO report, More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities, go to: www.gao.gov/new.items/d05366.pdf.>

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