Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 3. Rehabilitation Hospitals


While all the case study organizations expanded the types of uses for skilled nursing facilities, they differ in their use of rehabilitation hospitals. Keystone East and Kaiser Colorado make little use of rehabilitation hospitals, relying instead on skilled nursing facilities able to handle subacute patients. Keystone East uses rehabilitation hospitals mostly for patients with brain injuries, those with multiple traumas, and those requiring weaning from breathing aids, such as respirators. Kaiser Colorado uses them principally for enrollees with head trauma, spinal cord injury, and complex strokes. In contrast, HMO Oregon makes considerable use of rehabilitation hospitals, applying the standard Medicare coverage rules--for example, that the enrollee show potential for functional improvement and be able to tolerate three or more hours a day of therapy.

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