{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:11:03Z","timestamp":1780398663643,"version":"3.54.1"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,8,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265\u00a0444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95\u20131.00). Lower odds of IRF versus home discharge were observed in people aged &lt;65 years (aOR, 0.92; 95% CI, 0.89\u20130.96), Western states (aOR, 0.89; 95% CI, 0.84\u20130.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86\u20130.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11\u20131.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020528","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T09:36:18Z","timestamp":1628847378000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Association Between 2010 Medicare Reform and Inpatient Rehabilitation Access in People With Intracerebral Hemorrhage"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5013-622X","authenticated-orcid":false,"given":"Nneka L.","family":"Ifejika","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX"},{"name":"Department of Neurology UT Southwestern Medical Center Dallas TX"},{"name":"Department of Population and Data Sciences UT Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3464-2111","authenticated-orcid":false,"given":"Farhaan S.","family":"Vahidy","sequence":"additional","affiliation":[{"name":"Centers for Outcomes Research Houston Methodist Research Institute Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8019-6343","authenticated-orcid":false,"given":"Mathew","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics College of Human Medicine Michigan State University Lansing MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1237-1162","authenticated-orcid":false,"given":"Ying","family":"Xian","sequence":"additional","affiliation":[{"name":"Department of Neurology Duke University Hospital Durham NC"},{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Liang","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-5400","authenticated-orcid":false,"given":"Roland","family":"Matsouaka","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":false,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology Ahmanson\u2010UCLA Cardiomyopathy CenterUniversity of CaliforniaLos Angeles, Medical Center Los Angeles CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3667-4248","authenticated-orcid":false,"given":"James C.","family":"Grotta","sequence":"additional","affiliation":[{"name":"Stroke Research and Mobile Stroke Unit Memorial Hermann Hospital\u2013Texas Medical Center Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0198"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540290048031"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1998.tb01537.x"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(95)80501-X"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.07.023"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2017.09.005"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16646"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000069"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000098"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e3181c9fb40"},{"key":"e_1_3_1_13_2","unstructured":"Gage B Smith L Coots L Macek J III Manning J Reilly K. 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Federal Register. 2009;74:39762\u201039838."},{"key":"e_1_3_1_23_2","unstructured":"CMS National Provider Training Call Transcript . \u201cRevised Inpatient Rehabilitation Facility Prospective Payment System Coverage Requirements \u201d 2009 pp. 4\u20135. https:\/\/www.cms.gov\/Medicare\/MedicareFee\u2010for\u2010Service\u2010Payment\/InpatientRehabFacPPS\/Coverage.html. Accessed July 12 2020."},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.024155"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnur.2019.04.004"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.016931"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181e359df"},{"key":"e_1_3_1_28_2","unstructured":"Office of Inspector General Department of Health and Human Services. Many Inpatient Rehabilitation Facility Stays Did Not Meet Medicare Coverage and Documentation Requirements 2018. 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