Prospective payment for rehabilitation: effects on hospital readmission, home care, and placement.

Suspected benefits of a prospective payment system (PPS) in which hospitals are paid by diagnosis-related groups (DRGs) are that hospital lengths of stay and costs may be reduced. The US Department of Veterans Affairs is one of the first agencies to adopt PPS funding for rehabilitation; this early adoption of PPS provides a unique opportunity to test for both beneficial and adverse outcomes. This study compared hospital stay, readmission rate, and incidence of nursing home placement before and after introduction of PPS on a 22-bed rehabilitation service. Hospital stay decreased from 29.3 days to 26.4 days, but 64% more patients were discharged to nursing homes. Findings suggest that PPS may overlook home care in favor of placement, which neutralizes the cost benefits of the proposed reimbursement system. Further research on the effects of PPS is needed to determine (1) impact on clinical aspects of rehabilitation and (2) whether other funding mechanisms are more appropriate.

Timing of social work intervention and medical patient's length of hospital stay.

Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t-tests indicated a significant difference in the mean length of stay based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization, and that this methodology may be used reliably to evaluate changes in discharge planning protocol.