Consensus of Medical and Systemic Factors Affecting Admission to CMS-Eligible Inpatient Rehabilitation Facilities in New York State

Background and/or Objectives: To examine the impact of medical and socioeconomic factors on acceptance into inpatient rehabilitation facilities (IRFs) in New York State (NYS).

Design: Cross-sectional survey study

Setting : IRFs in NYS

Participants : 42 Centers for Medicare and Medicaid Service (CMS) - eligible facilities were identified on Medicare.gov. 2 of which did not have an IRF. Thirty-five percent or 14 facilities responded.

Interventions: The IRF’s medical director or admission liaison was emailed a survey with 28 questions assessing facility (5), medical (15) and socioeconomic (8) factors that influence an IRF’s decision to approve an admission, per year.

Main Outcome Measures: A Likert scale of 0=Never (0%), 1=Rarely ( < 25% of the time), 2=Occasionally (25-49% of the time), 3= Usually (50-89% of the time), 4=Always (90-100% of the time) was used. Additional publicly available characteristics (free standing, academic, non-profit, etc.) were also collected and assessed.

Results: The average bed count was 47.5 (SD 44.1), 79% were non-profit, 64% were urban-based, 14% were freestanding, and 64% were academic centers. Medical factors that did not appear to negatively impact the likelihood of admission included need for IV antibiotics (3.4, SD 1.1) and isolation precautions (3.3, SD 1.1). Need for radiation therapy was associated with a low likelihood of acceptance (0.9, SD 1.3) as were patients requiring a coma-stim program (0.6, SD 0.9). The presence of >30% non-qualifying CMS diagnosis in an IRF did not preclude admission (2.6, SD 0.6) but absence of a clear discharge plan (0.9, SD 0.5) and no insurance coverage (1.1, SD 0.8) were associated with a lower likelihood of acceptance.

Conclusions: Specific medical and socioeconomic factors are clearly associated with a lower probability of acceptance into an IRF. These factors should be considered during discharge planning to facilitate the appropriate level of post-acute care. Further studies should examine regional differences in admission standards for IRFs.