Optimizing Cancer Rehabilitation: Policy Implications 1137

Abstract

Objectives

To evaluate the impact of the current inpatient rehabilitation facility (IRF) admission criteria, specifically the “60% rule,” on access to rehabilitation services for patients with cancer. It seeks to assess potential modifications to the criteria to better align with the needs of this patient population.

Design

Using Bardach's Eightfold Path for Policy Analysis, this research conducts a comprehensive evaluation of the existing IRF admission criteria and their implications for cancer patients’ access to rehabilitation services. A literature review was conducted to gather evidence on the historical context, policy development, and current challenges related to IRF admission criteria.

Setting

The study focuses on the United States health care system, particularly Medicare's reimbursement policies for IRFs under the Prospective Payment System.

Participants

The participants include patients with cancer who may require postacute rehabilitation services, policymakers, health care providers, and stakeholders involved in the development and implementation of IRF admission criteria.

Interventions

The interventions assessed in this study include potential modifications to the existing IRF admission criteria, such as reducing the 60% rule threshold, expanding the list of compliant conditions to include cancer, or restricting the criteria to Medicare and Medicaid beneficiaries.

Main Outcome Measures

The main outcome measure is the impact of proposed modifications to the IRF admission criteria on access to rehabilitation services for patients with cancer. This includes assessing changes in admission rates, functional outcomes, health care utilization, and patient satisfaction.

Results

The analysis reveals that the current IRF admission criteria, particularly the 60% rule, present barriers to access for patients with cancer despite evidence of functional improvement with rehabilitation services. Proposed modifications, such as expanding the list of compliant conditions to include cancer, have the potential to increase access and improve outcomes for this patient population.

Conclusions

Modifications to the IRF admission criteria are necessary to better meet cancer patients’ rehabilitation needs. Expanding eligibility criteria and aligning policies with initiatives such as the Cancer Moonshot can enhance access to rehabilitation services and improve the quality of life for individuals with cancer.

Disclosures

I am employed as an assistant professor in the Vera Z. Dwyer College of Health Sciences at Indiana University South Bend. I have no other financial or nonfinancial disclosures to report.