Type of insurance affects use and intensity of postacute care for stroke survivors
Research Activities, December 2012, No. 388
Your insurance may play a role in how much post-acute care you get following a stroke, suggests a new study. It found that both uninsured and Medicaid-insured stroke survivors were less likely to use an inpatient rehabilitation facility (IRF) for post-stroke rehabilitation than a skilled nursing facility (SNF) compared with privately insured stroke survivors. What's the difference? The intensity of post-acute care varies from at least 3 hours of rehabilitation per day in an IRF to variable amounts of less frequent and intense rehabilitation in a SNF.
University of Michigan and Duke University researchers retrospectively studied 33,917 working-age stroke survivors from the 2004-2006 Nationwide Inpatients Sample. They looked at their use of any institutional post-acute care following hospitalization for stroke. Among Medicaid-insured stroke survivors who used institutional postacute care, 51 percent were discharged to a SNF compared to 27 percent of the privately insured.
One reason for this may be that the SNFs are less expensive than the IRFs. Based on Medicare payments, the use of an IRF leads to an average of $10,121 more spending than the use of a SNF. Another reason may be that stroke survivors insured by Medicaid may have greater preexisting disability and are thus better candidates for using an SNF. The researchers note that although no definitive trials address the impact of rehabilitation intensity on poststroke outcomes, the available evidence suggests that IRFs are associated with better outcomes than SNFs. This study was supported in part by the Agency for Healthcare Research and Quality (HS19479).
See "Effect of insurance status on postacute care among working age stroke survivors," by Lesli E. Skolarus, M.D., Willliam J. Meurer, M.D., James F. Burke, M.D., and others in Neurology 78, pp. 1590-1595, 2012.