As we have previously documented, almost all Medicare Advantage (MA) enrollees are subject to prior authorization for post-acute care (PAC) services. MA plans use prior authorization and other utilization management tools to shift patients toward lower cost PAC settings. In 2024, post-hospital use of institutional PAC, such as inpatient rehabilitation and skilled nursing facilities, was 7 percentage points lower for MA enrollees as compared to fee-for-service (FFS).
In this blog post, we take a deeper dive by examining use of inpatient rehabilitation facilities (IRFs) in MA and FFS. We examined trends in use of IRFs and compared rates of discharge to IRFs to rates of discharge to skilled nursing facilities (SNFs). To complete the analysis, we used data from 2018 through 2024 MedPAR files. The analysis was limited to hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS). To identify discharge location, we use discharge destination codes on the MedPAR record. MA discharges were identified based on information-only records required to be submitted by IPPS hospitals. The analysis reported in this blog was previously presented at the American Medical Rehabilitation Providers Association 2025 Fall Conference.
Patients Discharged to an IRF Increased by 17% Between 2018 and 2024
Between 2018 […]
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Lane Koenig is President and Founder of KNG Health Consulting and Director of the Healthcare Reform and Payment Innovation Practice. He is a healthcare economist with over 20 years’ experience in the public and private sectors. As President of KNG Health Consulting, Dr. Koenig has overall responsibility for the quality and direction of KNG Health’s research. He serves as Project Director and Principal Investigator for many studies, particularly those related to healthcare reform proposals, healthcare provider payments, value-based purchasing, and delivery system innovations. With expertise on hospital and post-acute care payment and quality issues, his work regularly assesses the potential impact on hospitals and other providers of proposed legislation or regulations. He has assisted both industry and Federal and state governments in the development and assessment of healthcare provider payment policies and value-base purchasing initiatives. Prior to founding KNG Health in 2007, Dr. Koenig was the senior economist in the Office of Policy at the Centers for Medicare & Medicaid Services (CMS). Before joining CMS, Dr. Koenig was a Senior Scientist in the healthcare finance practice at The Lewin Group. Dr. Koenig has led over 100 quantitative and qualitative health policy and health economic studies and has published over 20 peer-reviewed studies in journals, such as Health Affairs, Health Services Research, and Medical Care. He graduated with Honors from the University of Florida, Gainesville and earned his PhD in Economics from the University of Maryland, College Park. |