SACS
A Policy Study of the Cost-Effectiveness of Institutional Subacute
Care Alternatives and Services
(SNF/Rehab Project)
Funded by: Health Care Financing Administration
Project Period: 5/90 - 7/96
The purpose of this study of skilled nursing facility and rehabilitation
hospital care provided to Medicare beneficiaries was to determine the most
cost-effective services for different types of Medicare patients and to
investigate prospective payment methods (including per case) for skilled
nursing facilities and rehabilitation hospitals. The study involved
collection of data on case mix, short- and long-term outcomes, and
longitudinal costs at 160 sites in 17 states. Primary data were collected
on over 3,000 patients. A detailed longitudinal analysis of clinical
outcomes was conducted for patients with stroke and hip fracture beginning
with the acute hospital stay and covering up to a year after the acute
episode. Data for these comparisons included patient interview information,
provider-assessment function, review of hospital records and radiological
studies (including hip x-rays and CT/MRI scans for strokes), and detailed
cost data provided by rehabilitation staff and from Medicare Part A and
Part B claims data.
Key Staff: Kramer, Eilertsen, Schlenker
Journal Articles:
Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB, Hrincevich CA, Tropea DA, Ahmad LA, Eckhoff DG. "Outcomes and Costs after Hip Fracture and Stroke: A Comparison of Rehabilitation Settings." JAMA 277(5): 396-404, 1997.
Kramer AM, Schlenker RE, Eilertsen TB, Hrincevich CA. "Stroke Rehabilitation in Nursing Homes." Topics in Stroke Rehabilitation 4(1): 53-63, 1997.
Schlenker RE, Kramer AM, Hrincevich CA, Eilertsen TB. "Rehabilitation Costs: Implications for Prospective Payment." Health Services Research 32(5): 651-668, 1997.
Eilertsen TB, Kramer AM, Schlenker RE, Hrincevich CA. "Application of FIM-FRG and RUG-III Systems Across Post Acute Settings." Medical Care 36(5): 695-705, 1998.
Research Monographs:
Kramer AM, Schlenker RE, Tropea DA, Eilertsen TB. Variation in Skilled Nursing Facility Care, Cost, and Outcomes: Preliminary Findings and Methodologic Issues. UCD Center for Health Services Research, Denver, Colorado. December 1991.
Hrincevich CA, Eilertsen TB, Kramer AM. Study of the Cost-Effectiveness of Institutional Subacute Care Alternatives and Services: Data Collection Report. UCD Center for Health Services Research, Denver, Colorado. February 1994.
Kramer AM, Eilertsen TB, Hrincevich CA, Schlenker RE. Rehabilitation of Medicare Patients in Rehabilitation Hospitals and Skilled Nursing Facilities. UCD Center for Health Services Research, Denver, Colorado. February 1994.
Kramer AM, Eilertsen TB, Hrincevich CA, Schlenker RE. Rehabilitation of Medicare Patients in Rehabilitation Hospitals and Skilled Nursing Facilities. UCD Center for Health Services Research, Denver, Colorado. November 1994.
Policy Presentations:
"Variation in Skilled Nursing Facility Care, Cost and Outcomes: Preliminary Findings and Methodologic Issues." Health Care Financing Administration. Baltimore, Maryland. 1991.
"Cost-Effectiveness of Skilled Nursing Facility and Rehabilitation Hospital Care: Preliminary Results." Health Care Financing Administration. Baltimore, Maryland. March 15, 1995.
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