Cancer Rehabilitation: Reconsidering the Inpatient Rehabilitation Facility Classification Criteria for Payment Under the Prospective Payment System.

Abstract

Inpatient rehabilitation facilities (IRFs) are crucial in enhancing the functionality of individuals requiring post-acute care. However, despite modifications in reimbursement systems, IRF admission criteria have remained relatively unchanged since the 1970s. As a result, and despite evidence of functional improvement, IRFs are still not widely used for cancer patients' rehabilitation needs. President Biden relaunched the Cancer Moonshot in 2022 with the aim of enhancing the quality of life for individuals with cancer. To improve the quality of life for cancer patients and meet their rehabilitation needs, it is essential to assess IRF admission and reimbursement procedures. Utilizing Bardach's Eightfold Path for Policy Analysis, the so-called "60% rule," and potential alternatives are evaluated to address the impact on cancer patients' access to IRF-level rehabilitation. Expanding the list of conditions eligible for IRF-level care could significantly increase access for those with a cancer diagnosis with minimal legislative intervention. This approach could also enhance the efficiency of these services by enabling providers to become more attuned to the unique needs of cancer patients. Although this may entail higher costs initially, long-term savings can be realized through reduced disability costs and improved quality of life for patients.