Selecting a rehabilitation program for people with stroke.

Abstract

This article reviews the 1997 Balanced Budget Act as it pertains to Medicare reimbursement and its consequent impact on medical rehabilitation in general and on persons with stroke in particular. Following a description of the concept and practice of "consumer choice" in health care today, the author frames "choice" in the context of outcomes management wherein the person with stroke may be provided with a report card that describes what outcomes the patient might expect following a course of rehabilitation. Today more than ever, patients are beginning to require information about provider performance that is easy to understand and allows for them to make intelligent purchasing decisions. Literature is reviewed that documents better stroke outcomes in specific types of rehabilitation settings. Finally, a variety of existing consumer tools are reviewed that assist the person with stroke in making an enlightened choice for an optimal setting for stroke rehabilitation. Unfortunately, persons with stroke may not consistently be able to exercise an educated choice because the payer may independently determine placement. An extensive consumer check list of quality indicators is provided to enable the patient's family and provider to evaluate the appropriateness of placing a person with stroke in a given setting.