Dr. Justin Liu, MD
Acute Rehabilitation: Is It Right For Your Patients?
by Justin Liu, MD on February 29th, 2016

    Regardless of the healthcare system I have been the director at, it seems that there is always a shroud of mystery when clinicians try to decipher what exactly Inpatient Acute Rehab is all about.  The most common conclusion that I have encountered is that Acute Rehab is essentially just like a Skilled Nursing Facility.

    While Acute Rehab may accept similar patients as SNFs, the differences between the two are quite profound.  Without delving into a novel about this, my goal in this short column is to hopefully shed some light on Rehab and how it can potentially benefit the patients you encounter.

    First things first.  Who is appropriate for Acute Rehab?  As many of you have probably guessed, the large majority of Rehab patients are those affected by neurologic and orthopedic conditions.  These typically include stroke, brain tumors, traumatic brain injury, spinal cord injury, Parkinson’s exacerbation, Multiple Sclerosis exacerbation, Guillain-Barre Syndrome, hip/pelvic fractures, limb amputations and spinal stenosis requiring decompressive spinal surgery.  CMS mandates that all Rehab Units must have at least 60% of their admitted patients fall into what is deemed an “appropriate” Rehab diagnosis.  While most physicians are aware of the more conventional patient diagnoses that can be referred to Acute Rehab, most are often unaware that Rehab Units are allowed to have up to 40% of their total admissions accommodate more atypical diagnoses.  These patients are the ones who have sustained acute functional decline due to their recent medical issues.  Regardless of whether the medical issues are cardiac, pulmonary, infectious, etc...CMS has a diagnosis category known as “Debility” to classify patients that have sustained acute functional decline due to recent medical complexity.  While we don’t exactly have carte blanche to take every single patient that is admitted to the hospital, the Debility diagnosis does allow Rehab Units to have much more flexibility with whom they can consider accepting.

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