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ARTICLE |

Outcomes for Patients With Stroke in Managed Care vs Fee-for-Service FREE

James R. Swenson, MD
JAMA. 1997;278(16):1315-1315. doi:10.1001/jama.1997.03550160035018
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To the Editor.  —We are encouraged that Dr Retchin and colleagues1 have re-energized important dialogue concerning the benefits of acute rehabilitation and the rationing of this care, which has become all too commonplace in managed care environments.Physiatrists have been active in Medicare and Medicaid reform issues, advocating for the chronically ill and disabled to ensure that these at-risk populations maintain adequate access to care, in particular, necessary acute rehabilitation services provided in appropriate rehabilitation settings. The cost of this intensive therapy can be high, but it has repeatedly been shown to be highly effective.2,3As noted by Drs Webster and Feinglass,4 the implication that health maintenance organizations (HMOs) are denying patients this optimal rehabilitation therapy to save money is "disturbing" and "worrisome." But is this really news to physicians, or is this finally the last straw? Will we continue to witness the erosion of quality care

REFERENCES

Retchin SM, Brown RS, Yeh SJ, Chu D, Moreno L.  Outcomes of stroke patients in Medicare fee for service and managed care . JAMA . 1997;;278:119-124.
Kramer AM, Steiner JF, Schlenker KB, et al.  Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings . JAMA . 1997;;277:396-404.
Mulcahy C.  Rehab saves $35 for every $1 spent . National Underwriter . May 9, 1994;:17-18.
Webster JR, Feinglass J.  Stroke patients, managed care, and distributive justice . JAMA . 1997;;278:161-162.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Retchin SM, Brown RS, Yeh SJ, Chu D, Moreno L.  Outcomes of stroke patients in Medicare fee for service and managed care . JAMA . 1997;;278:119-124.
Kramer AM, Steiner JF, Schlenker KB, et al.  Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings . JAMA . 1997;;277:396-404.
Mulcahy C.  Rehab saves $35 for every $1 spent . National Underwriter . May 9, 1994;:17-18.
Webster JR, Feinglass J.  Stroke patients, managed care, and distributive justice . JAMA . 1997;;278:161-162.
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To understand the clinical management of acute heart failure syndromes.
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