Current Evidence on the Impact of Medicare Payment Policy on Stroke Rehabilitation in Skilled Nursing Facilities

Purpose of ReviewPatients recovering from stroke benefit from frequent, multi-disciplinary therapies in skilled nursing facilities (SNFs). As a major driver of spending, rehabilitation in SNFs is vulnerable to scrutiny from payers including Medicare. This review explored impacts of current payment programs (Patient Driven Payment Model, Bundled Payments for Care Improvement Advanced, Accountable Care Organizations, and Medicare Advantage) on access and outcomes of rehabilitation in SNFs after stroke.Recent FindingsThere is minimal SNF payment research specific to stroke. For the general Medicare population, payment programs frequently reduced access to SNFs and rehabilitation services within SNFs, but utilization for patients with stroke was less impacted. Payment programs had mixed or no impact on mortality and hospital readmission after stroke.Reductions in utilization of SNF rehabilitation resulted in mostly neutral outcomes, including for patients with stroke. Future research should investigate the impact of payment policies on important stroke recovery outcomes such as functional improvement.