Wagner, Todd H. and Richardson, Samuel S. and Vogel, Bruce and Wing, Kristen and Smith, Mark W. (2006): Cost of inpatient rehabilitation care in the Department of Veterans Affairs. Published in: Journal of Rehabilitation Research & Development , Vol. 43, No. 7 (November 2006): pp. 929-938.
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Abstract
Abstract—We investigated the determinants of inpatient rehabilitation costs in the Department of Veterans Affairs (VA) and examined the relationship between length of stay (LOS) and discharge costs using data from VA and community rehabilitation hospitals. We estimated regression models to identify patient characteristics associated with specialized inpatient rehabilitation costs. VA data included 3,535 patients discharged from 63 facilities in fiscal year 2001. We compared VA costs to community rehabilitation hospitals using a sample from the Uniform Data System for Medical Rehabilitation of 190,112 patients discharged in 1999 from 697 facilities. LOS was a strong predictor of cost for VA and non-VA hospitals. Functional status, measured by Functional Independence Measure (FIM) scores at admission, was statistically significant but added little explanatory value after controlling for LOS. Although FIM scores were associated with LOS, FIM scores accounted for little variance in cost after controlling for LOS. These results are most applicable to researchers conducting cost-effectiveness analyses.
Item Type: | MPRA Paper |
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Original Title: | Cost of inpatient rehabilitation care in the Department of Veterans Affairs |
Language: | English |
Keywords: | average costs, billing, charges, cost, health economics, micro-cost methods, reimbursement, rehabilitation, VA, veterans |
Subjects: | I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health I - Health, Education, and Welfare > I1 - Health |
Item ID: | 12042 |
Depositing User: | Mark W Smith |
Date Deposited: | 06 Jan 2009 06:28 |
Last Modified: | 30 Sep 2019 15:13 |
References: | 1. Wagner TH, Chen S, Yu W, Barnett PG. HERC’s average cost data for VA inpatient Care: 1998–2004. Menlo Park (CA): Department of Veterans Affairs Health Economics Resource Center; 2005. 2. Ashton CM, Souchek J, Petersen NJ, Menke TJ, Collins TC, Kizer KW, Wright SM, Wray NP. Hospital use and survival among Veterans Affairs beneficiaries. N Engl J Med. 2003;349(17):1637–46. [PMID: 14573736] 3. Chen S, Smith MW, Wagner TH, Barnett PG. Spending for specialized mental health treatment in The VA: 1995–2001. Health Aff (Millwood). 2003;22(6):256–63. [PMID: 14649454] 4. Chen S, Wagner TH, Barnett PG. The effect of reforms on spending for veterans’ substance abuse treatment, 1993– 1999. Health Aff (Millwood). 2001;20(4):169–75. [PMID: 11463073] 5. Yu W, Ravelo A, Wagner TH, Barnett PG. The relationships among age, chronic conditions, and healthcare costs. Am J Manag Care. 2004;10(12):909–16. [PMID: 15617366] 6. Barnett PG, Rodgers JH. Use of the Decision Support System for VA cost-effectiveness research. Med Care. 1999;37(4 Suppl VA):AS63–70. [PMID: 10217386] 7. Wagner TH, Velez J. A Comparison for inpatient costs from the HERC and DSS National Data Extract Sata Sets. Menlo Park (CA): Department of Veterans Affairs Health Economics Resource Center; 2004. 8. Luke RD. Dimensions in hospital case mix measurement. Inquiry. 1979;16(1):38–49. [PMID: 155039] 9. Harada N, Kominski G, Sofaer S. Development of a resource-based patient classification scheme for rehabilitation. Inquiry. 1993;30(1):54–63. [PMID: 8454315] 10. Burnett DM, Cifu DX, Kolakowsky-Hayner S, Kreutzer JS. Predicting “charge outliers” after spinal cord injury: A multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation charges. Arch Phys Med Rehabil. 2001;82(1):114–19. [PMID: 11239296] 11. Brosseau L, Philippe P, Potvin L, Boulanger YL. Poststroke inpatient rehabilitation. I. Predicting length of stay. Am J Phys Med Rehabil. 1996;75(6):422–30. [PMID: 8985105] 12. Stineman MG, Hamilton BB, Goin JE, Granger CV, Fiedler RC. Functional gain and length of stay for major rehabilitation impairment categories. Patterns revealed by functionrelated groups. Am J Phys Med Rehabil. 1996;75(1):68–78. [PMID: 8645443] 13. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil. 1994;75(2): 133–43. [PMID: 8311668] 14. Rondinelli RD, Murphy JR, Wilson DH, Miller CC. Predictors of functional outcome and resource utilization in inpatient rehabilitation. Arch Phys Med Rehabil. 1991;72(7): 447–53. [PMID: 1905529] 15. Roth EJ, Lovell L, Harvey RL, Bode RK, Heinemann AW. Stroke rehabilitation: Indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke. 2002;33(7): 1845–50. [PMID: 12105364] 16. Reker DM, O’Donnell JC, Hamilton BB. Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: Accounting for case-mix. Arch Phys Med Rehabil. 1998;79(7):751–57. [PMID: 9685086] 17. Stineman MG, Ross RN, Hamilton BB, Maislin G, Bates B, Granger CV, Asch DA. Inpatient rehabilitation after stroke: A comparison of lengths of stay and outcomes in the Veterans Affairs and non-Veterans Affairs health care system. Med Care. 2001;39(2):123–37. [PMID: 11176550] 18. Stineman MG, Escarce JJ, Goin JE, Hamilton BB, Granger CV, Williams SV. A case-mix classification system for medical rehabilitation. Med Care. 1994;32(4):366–79. [PMID: 8139301] 19. Carter GM, Relles DA, Ridgeway GK, Rimes CM. Measuring function for Medicare inpatient rehabilitation payment. Health Care Financ Rev. 2003;24(3):25–44. [PMID: 12894633] 20. Carter GM, Buchanan JL, Buntin MB, Hayden O, Paddock S, Relles DA, Ridgeway G, Totten M, Wynn B. Executive summary for the analyses for the initial implementation of the inpatient rehabilitation facility prospective payment system. Santa Monica (CA): RAND; 2002. 21. Harvey RL, Roth EJ, Heinemann AW, Lovell LL, McGuire JR, Diaz S. Stroke rehabilitation: Clinical predictors of resource utilization. Arch Phys Med Rehabil. 1998;79(11): 1349–55. [PMID: 9821892] 22. Cowen TD, Meythaler JM, DeVivo MJ, Ivie CS 3rd, Lebow J, Novack TA. Influence of early variables in traurelated groups. Am J Phys Med Rehabil. 1996;75(1):68–78. [PMID: 8645443] 13. Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil. 1994;75(2): 133–43. [PMID: 8311668] 14. Rondinelli RD, Murphy JR, Wilson DH, Miller CC. Predictors of functional outcome and resource utilization in inpatient rehabilitation. Arch Phys Med Rehabil. 1991;72(7): 447–53. [PMID: 1905529] 15. Roth EJ, Lovell L, Harvey RL, Bode RK, Heinemann AW. Stroke rehabilitation: Indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke. 2002;33(7): 1845–50. [PMID: 12105364] 16. Reker DM, O’Donnell JC, Hamilton BB. Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: Accounting for case-mix. Arch Phys Med Rehabil. 1998;79(7):751–57. [PMID: 9685086] 17. Stineman MG, Ross RN, Hamilton BB, Maislin G, Bates B, Granger CV, Asch DA. Inpatient rehabilitation after stroke: A comparison of lengths of stay and outcomes in the Veterans Affairs and non-Veterans Affairs health care system. Med Care. 2001;39(2):123–37. [PMID: 11176550] 18. Stineman MG, Escarce JJ, Goin JE, Hamilton BB, Granger CV, Williams SV. A case-mix classification system for medical rehabilitation. Med Care. 1994;32(4):366–79. [PMID: 8139301] 19. Carter GM, Relles DA, Ridgeway GK, Rimes CM. Measuring function for Medicare inpatient rehabilitation payment. Health Care Financ Rev. 2003;24(3):25–44. [PMID: 12894633] 20. Carter GM, Buchanan JL, Buntin MB, Hayden O, Paddock S, Relles DA, Ridgeway G, Totten M, Wynn B. Executive summary for the analyses for the initial implementation of the inpatient rehabilitation facility prospective payment system. Santa Monica (CA): RAND; 2002. 21. Harvey RL, Roth EJ, Heinemann AW, Lovell LL, McGuire JR, Diaz S. Stroke rehabilitation: Clinical predictors of resource utilization. Arch Phys Med Rehabil. 1998;79(11): 1349–55. [PMID: 9821892] 22. Cowen TD, Meythaler JM, DeVivo MJ, Ivie CS 3rd, Lebow J, Novack TA. Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges. Arch Phys Med Rehabil. 1995;76(9):797–803. [PMID: 7668948] 23. Andrews AW, Bohannon RW. Discharge function and length of stay for patients with stroke are predicted by lower extremity muscle force on admission to rehabilitation. Neurorehabil Neural Repair. 2001;15(2):93–97. [PMID: 11811257] 24. Cifu DX, Huang ME, Kolakowsky-Hayner SA, Seel RT. Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equina. J Neurotrauma. 1999; 16(9):805–15. [PMID: 10521140] 25. Gold MR, Siegel JE, Russell LB, Weinstein MC. Costeffectiveness in health and medicine. Oxford (England): Oxford University Press; 1996. 26. Yu W, Wagner TH, Chen S, Barnett PG. Average cost of VA rehabilitation, mental health, and long-term hospital stays. Med Care Res Rev. 2003;60(3 Suppl):40S–53S. [PMID: 15095545] 27. Duan N. Smearing estimate: A nonparametric retransformation method. J Am Stat Assoc. 1983;78(383):605–10. 28. Ai C, Norton EC. Standard errors for the retransformation problem with heteroscedasticity. J Health Econ. 2000; 19(5):697–718. [PMID: 11184800] 29. Blough DK, Madden CW, Hornbrook MC. Modeling risk using generalized linear models. J Health Econ. 1999; 18(2):153–71. [PMID: 10346351] 30. Gertler PJ, Waldman DM. Quality-adjusted cost functions and policy evaluation in the nursing home industry. J Polit Econ. 1992;100(6):1232–56. 31. Frank RG, Berndt ER, Busch SH. Price indexes for the treatment of depression. Washington (DC): Brookings Institution Press; 1999. 32. Wagner TH, Chen S, Barnett PG. Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA. Med Care Res Rev. 2003;60(3 Suppl): 15S–36S. [PMID: 15095543] |
URI: | https://mpra.ub.uni-muenchen.de/id/eprint/12042 |