2004S-0170 - Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Section 1013: Suggest Priority Topics for Research
FDA Comment Number : EC34
Submitter : Dr. Stephanie Carter Date & Time: 05/14/2004 06:05:30
Organization : Dr. Stephanie Carter
Health Professional
Category :
Issue Areas/Comments
These questions are related to outpatient rehabilitation reimbursement.

1) What pattern of patient characteristics/factors (e.g. age, functional level, diagnosis) result in discrete categories upon which to base payment? Can diganostic groups be created for payment of outpatient rehabilitation? At least in broad categories of musculoskeletal vs. neurological or chronic vs. acute.

2) What is the expected functional outcome for each diagnostic classification?
What rehabilitation interventions result in the best functional outcome for each diagnostic classification and at what cost?
-This would reduce overutilization of rehab services and insure appropriate rehabilitation.

3) Determine what type of facility (CORF, physician office, PT office) provides the most cost effective rehabilitation (i.e. best functional outcome for the lowest cost).
-Physical therapy is not always provided by a physical therapist. There is some evidence that physician owned physical therapy overutilizes these services. Is this true for the Medicare patients? Should limits on reimbursement be set for certain types of facilities? Is care different per provider?

4) What is the appropriate pattern of utilization for patients with chronic neurologic diagnoses (e.g. stroke, tbi, etc.)? The hypothesis is that care does not need to be continuous.

5) Is the care different in Part B for patients that are institutionalized (in Skilled Nursing) than for patients that are not institutionalzed? If a difference exists, is it appropriate or not?