Inpatient rehabilitation utilization for Medicare beneficiaries with multiple sclerosis
OBJECTIVE: To explore the use of inpatient rehabilitation facility services and levels of impairment for Medicare beneficiaries with MS by comparing differences in service utilization and clinical characteristics between Medicare beneficiaries with MS to the overall Medicare population. DESIGN: Medicare beneficiaries with MS were identified using Medicare claims data. Claims and assessment data were analyzed to compare outcomes for beneficiaries with MS who used inpatient rehabilitation compared to a random sample of Medicare beneficiaries without MS. SETTING: Inpatient rehabilitation facilities. PARTICIPANTS: Medicare beneficiaries with a diagnosis of MS who received inpatient rehabilitation during calendar year 2007 (N=4,669) and random sample of Medicare beneficiaries without Multiple Sclerosis (N=14,397). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in functional impairment levels between admission and discharge to inpatient rehabilitation and length of stay. RESULTS: There were several differences in beneficiary characteristics between the two groups. Beneficiaries with MS had lower change in functional levels (-3.3 points on FIM(R)) and longer length of stay (+0.4 days). CONCLUSIONS: While beneficiaries with MS account for a small proportion of the Medicare population, the benefit is important to those who qualify for Medicare coverage. This study illustrates the differences between the subpopulation of beneficiaries with MS and other Medicare beneficiaries. The findings show that populations with MS had less functional improvement than other Medicare populations using the inpatient rehabilitation setting. Higher rates of depression within the MS Medicare population was a secondary finding that presents another important consideration for rehabilitation service needs for this group.