Press Release

Clock is Ticking on Congress' Opportunity to Preserve Inpatient Rehab Care




Today, the American Hospital Association (AHA), American Medical Rehabilitation Providers Association (AMRPA), and the Federation of American Hospitals (FAH) urged Congress to enact important legislation that would preserve Medicare beneficiaries' access to critical inpatient rehabilitation services before a July 1st deadline that would further restrict their access. 

The legislation - the "Preserving Patient Access to Inpatient Rehabilitation Hospitals Act" (H.R. 1459/S. 543) - would do so by extending enforcement of the 75 Percent Rule at its current level.  In urging passage of the legislation, the Associations thanked the bill's current cosponsors, who comprise nearly half of all Members of Congress.

The bill would prevent the 75 Percent Rule from further eroding access to inpatient rehabilitation care for people with disabilities, seniors, and others who require this level of care.  The 75 Percent Rule is a Medicare requirement established in 1983 that has been significantly narrowed but never revised to capture conditions now treatable due to medical advancements.  When fully phased-in, 75 percent of patients discharged from an inpatient rehabilitation hospital or unit must be treated for one of 13 conditions.  The threshold currently is set at 60 percent but is scheduled to rise to 65 percent on July 1, 2007 and 75 percent in July 2008.

"Patients should receive rehabilitation in the most appropriate setting of care.  Regrettably, the 75 Percent Rule, as currently constituted, undermines that goal and puts seniors at risk.  The 75 Percent Rule's arbitrary patient 'lottery' must be permanently fixed for the benefit of all patients - Medicare and non-Medicare alike," said Kathleen Yosko, President and CEO of Marianjoy Rehabilitation Hospital and AMRPA Board Chair. 

"The 75 Percent Rule is severely restricting access to inpatient rehabilitation for patients who need this specialized setting," said Rich Umbdenstock, AHA President and CEO.  "Our mission is to provide our patients with the best care at the right time and in the most appropriate setting.    The 75 Percent Rule is putting a stranglehold on access to this vital care, making it more difficult for frail, elderly patients to get the services they need."    

Due to the 75 Percent Rule, many appropriate patients previously served in rehabilitation hospitals and units are being denied access to clinically intense and promising inpatient rehabilitation services that are both medically necessary and would lead to superior patient outcomes in a shorter period of time than other settings might accomplish. 

"The 75 percent rule is not only arbitrary, it results in what amounts to Medicare patient quotas so that the rehabilitative needs of many seniors are not met.  This threatens the very entitlement to care for those seniors," remarked Chip Kahn, President of the Federation of American Hospitals. 

The rehabilitation field strongly supports legislation that would prevent further escalation of the percentage threshold because the rule, in three years, has far exceeded the government's fully-implemented savings and policy objectives. The Centers for Medicare & Medicaid Services (CMS) estimated that during the first two years of the 75 Percent Rule's phase-in, only 7,000 fewer patients would be treated.  However, a study conducted by The Moran Company found a caseload decline of 88,000 patients in rehabilitation hospitals or units during that time period because of the 75 Percent Rule. 

Inpatient rehabilitation hospitals and units provide acute hospital-level care that is overseen by specialty-trained physicians and registered nurses who coordinate care for patients' medical and rehabilitation needs.  Rehabilitation physicians and rehabilitation nurses must be available on a 24-hour basis and a physician must regularly see the patient.  The multi-disciplinary care provided by inpatient rehabilitation hospital doctors, nurses, and therapists is unmatched by other health settings. 

In other health settings, such as nursing homes, there is no physician-on-duty requirement, no requirement for an interdisciplinary team approach or coordination among therapists, and no minimum requirements for the amount of therapy provided.  In addition, the Medicare Payment Advisory Commission (MedPAC) has reported that the quality of care in nursing homes is deteriorating - while hospital readmissions are rising, discharges to the community are falling, and patients cared for in skilled nursing facilities are more frequently readmitted to general acute hospitals for follow-up care, increasing cost of care and further delaying patients' return to their homes.

A case in point: an article published January 2006 in the American Journal of Physical Medicine and Rehabilitation by Walsh, et al, found that patients recovering from single joint replacement surgery spent twice as long in the nursing home setting as in the rehabilitation hospital, had lower function on discharge despite being the same on admission, were more likely to require transfer back to the acute hospital from the nursing home, and were less likely to return home.

"For those of us involved in patient care, our goal is to get patients the care they need so they can return to their homes and families sooner and healthier.  That's the value that this specialized care provides to patients.  Shouldn't we give seniors the very best care we can?" said John Pellicone, M.D., Medical Director of Helen Hayes Hospital in West Haverstraw, New York.

"Obviously, nursing homes have a place in post acute care, but they have neither the capability nor capacity to meet the medical needs of seniors the way inpatient rehabilitation hospitals do, and it is disingenuous to suggest otherwise," added Mr. Kahn.

AHA, AMRPA, and FAH call upon Congress to act immediately to provide urgently needed legislative relief.  "It is critical that CMS policies are in the best interests of Medicare beneficiaries," said Ms. Yosko.  "We continue to believe that the paramount need is for clinical evidence on which to make valid decisions regarding appropriate sites of care for different patients.  Government policy should be evidence-based.  Important research is now underway and this work needs to take its course before the Rule is permitted to continue escalating toward the 75 percent level."

The bills were introduced by Reps. John Tanner (D-TN), Kenny Hulshof (R-MO), Nita Lowey (D-NY) and Frank LoBiondo (R-NJ); and Sens. Ben Nelson (D-NE), Jim Bunning (R-KY), Debbie Stabenow (D-MI) and Olympia Snowe (R-ME).

About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at

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