From CMS rules to top-ranked facilities, everything operators need to know about IRFs.

Why IRFs Matter, and What Every Operator Needs to Know

Inpatient Rehabilitation Facilities (IRFs) play a crucial role in our healthcare system, providing intensive rehabilitation services to patients recovering from serious conditions such as strokes, brain injuries, and spinal cord injuries. Understanding the operational rules, regulations, and key players in this sector is vital for healthcare professionals, policy makers, and patients alike. Below are five essential things to know about IRFs.

The 60% Rule: Why It’s the Gatekeeper for IRF Status

The 60% Rule is a critical Medicare regulation that determines whether a facility qualifies as an IRF. According to the rule, at least 60% of the facility's inpatient population must have one or more of 13 specified conditions, such as stroke, brain injury, or spinal cord injury. These conditions are deemed to require intensive rehabilitation services that IRFs are designed to provide.

The 60% Rule ensures that IRFs focus on patients who truly need specialized rehabilitation. This regulation is essential for maintaining the quality and effectiveness of care provided in these facilities. Compliance with the 60% Rule is monitored through periodic audits and reviews of patient records and facility admissions.

CMS 13: The Conditions That Define IRF Eligibility

The Centers for Medicare & Medicaid Services (CMS) 13 Requirements refer to the specific conditions that qualify a facility as an IRF under the 60% Rule. These conditions are:

• Stroke

• Spinal cord injury

• Congenital deformity

• Amputation

• Major multiple trauma

• Fracture of femur (hip fracture)

• Brain injury

• Neurological disorders (e.g., multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy, Parkinson’s disease)

• Burns

• Active, polyarticular rheumatoid arthritis, psoriatic arthritis, and seronegative arthropathies

• Systemic vasculitis with joint inflammation

• Severe or advanced osteoarthritis involving two or more major weight-bearing joints

• Knee or hip joint replacement, or both, during an acute hospitalization immediately preceding the IRF stay and also meets specific criteria

  
  

These requirements ensure that IRFs are appropriately serving patients with conditions that necessitate an elevated level of rehabilitative care. Facilities must document the qualifying conditions of their patients to meet the CMS 13 Requirements and thus comply with the 60% Rule.

The 3-Midnight Rule: What It Means for Medicare Patients

The 3-Midnight Rule is another crucial regulation for Medicare beneficiaries. It stipulates that a patient must have a prior inpatient hospital stay of at least three consecutive midnights to qualify for Medicare coverage for subsequent care in an IRF. This rule is designed to ensure that only patients who require intensive inpatient rehabilitation, as determined by their hospital stay, are admitted to IRFs.

The 3-Midnight Rule also helps manage healthcare costs by preventing unnecessary admission to IRFs and ensuring that patients receive the appropriate level of care based on their medical needs. Compliance with this rule requires thorough documentation of the patient's hospital stay and medical necessity for IRF services.

Who Owns the IRF Market? Meet the 3 Major Players

The market for IRFs in the United States is dominated by three major operators, who own and manage a sizable portion of these facilities. These operators are:

Encompass Health

Encompass Health is the largest owner and operator of IRFs in the United States. The company operates over 130 IRFs across the country, providing high-quality rehabilitation services to patients with a range of conditions. Encompass Health is known for its commitment to patient care, innovative treatment approaches, and comprehensive rehabilitation programs.

HealthSouth Corporation

HealthSouth Corporation, now a part of Encompass Health, was historically one of the largest operators of IRFs in the country. Before its acquisition, HealthSouth operated over 120 IRFs, offering a wide range of rehabilitation services to patients. The company's integration into Encompass Health has strengthened its position as a leading provider of inpatient rehabilitation.

Kindred Healthcare

Kindred Healthcare is another major player in the IRF market, operating numerous facilities nationwide. The company focuses on delivering specialized rehabilitation services, including physical, occupational, and speech therapy. Kindred Healthcare emphasizes patient-centered care and strives to help patients achieve their maximum potential for recovery.

Top-Ranked IRFs Setting the Standard for Patient Care

Several IRFs in the United States are consistently ranked among the best in the nation for their exceptional patient care, advanced treatment methods, and successful rehabilitation outcomes. Some of the highly ranked IRFs include:

TIRR Memorial Hermann (Houston, Texas)

TIRR Memorial Hermann is renowned for its comprehensive rehabilitation programs and innovative research in the field of rehabilitative medicine. The facility offers specialized care for patients with brain injuries, spinal cord injuries, strokes, and other complex conditions. TIRR Memorial Hermann's multidisciplinary team of experts provides personalized treatment plans to help patients achieve their recovery goals.

Shirley Ryan AbilityLab (Chicago, Illinois)

The Shirley Ryan AbilityLab, formerly known as the Rehabilitation Institute of Chicago, is consistently ranked as one of the top IRFs in the country. The facility is dedicated to advancing rehabilitative care through innovative research, state-of-the-art technology, and a patient-centered approach. The Shirley Ryan AbilityLab offers a wide range of rehabilitation services, including physical, occupational, and speech therapy, to help patients regain their independence.

Kessler Institute for Rehabilitation (West Orange, New Jersey)

The Kessler Institute for Rehabilitation is a leading IRF that provides specialized care for patients with neurological, orthopedic, and musculoskeletal conditions. The facility is known for its comprehensive rehabilitation programs, advanced treatment techniques, and commitment to patient outcomes. The Kessler Institute's team of experienced professionals works closely with patients to develop customized rehabilitation plans that address their unique needs and goals.

Craig Hospital (Englewood, Colorado)

Craig Hospital is a nationally recognized IRF specializing in the care of patients with spinal cord injuries and brain injuries. The facility offers a holistic approach to rehabilitation, focusing on the physical, emotional, and social aspects of recovery. Craig Hospital's multidisciplinary team of experts provides individualized care and support to help patients achieve their highest level of independence and quality of life.

Magee Rehabilitation Hospital (Philadelphia, Pennsylvania)

Magee Rehabilitation Hospital is known for its exceptional patient care and innovative rehabilitation programs. The facility offers specialized services for patients with spinal cord injuries, brain injuries, strokes, and other complex conditions. Magee Rehabilitation Hospital's dedicated team of professionals works collaboratively with patients to develop personalized treatment plans that promote recovery and enhance quality of life.

Key Takeaways for Operators Navigating the IRF Landscape

Inpatient Rehabilitation Facilities (IRFs) play a vital role in the healthcare system by providing specialized and intensive rehabilitation services to patients recovering from serious conditions. Understanding the key regulations, major operators, and top-ranked facilities in this sector is essential for healthcare professionals, policymakers, and patients alike. The 60% Rule and CMS 13 Requirements ensure that IRFs serve patients with conditions that necessitate an elevated level of rehabilitative care, while the 3-Midnight Rule helps manage healthcare costs and ensures appropriate admissions. The dominance of major operators like Encompass Health, HealthSouth Corporation, and Kindred Healthcare highlights the importance of these facilities in the healthcare landscape. Lastly, highly ranked IRFs such as TIRR Memorial Hermann, Shirley Ryan AbilityLab, Kessler Institute for Rehabilitation, Craig Hospital, and Magee Rehabilitation Hospital set the standard for excellence in rehabilitative care, helping patients achieve their maximum potential for recovery and independence.

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