Relationship Between Diabetes Codes That Affect Medicare Reimbursement (Tier Comorbidities) and Outcomes in Stroke Rehabilitation |
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Authors: | James E Graham Cynthia M Ripsin Anne Deutsch Yong-Fang Kuo Sam Markello Carl V Granger Kenneth J Ottenbacher |
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Institution: | a Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX b Department of Family Medicine, University of Texas Medical Branch, Galveston, TX c Department of Internal Medicine—Geriatrics, University of Texas Medical Branch, Galveston, TX d Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX e Rehabilitation Institute of Chicago, Chicago, IL f Uniform Data System for Medical Rehabilitation, Buffalo, NY |
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Abstract: | Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.ObjectivesTo examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.DesignSecondary data analysis.SettingInpatient rehabilitation facilities (N=864) across the United States.ParticipantsPatients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.InterventionNone.Main Outcome MeasuresLength of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.ResultsMean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.ConclusionsThe diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age. |
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Keywords: | Diabetes mellitus Prospective payment system Rehabilitation Stroke |
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