Rehabilitation complexity scale and reimbursement of in-hospital pulmonary rehabilitation

Michele Vitacca; Mara Paneroni; Nicolino Ambrosino

doi:10.4081/mrm.2023.936

Rehabilitation complexity scale and reimbursement of in-hospital pulmonary rehabilitation

Authors

Michele Vitacca Istituti Clinici Scientifici Maugeri
Mara Paneroni Istituti Clinici Scientifici Maugeri IRCCS - Institute of Lumezzane (Brescia)
Nicolino Ambrosino Istituti Clinici Scientifici Maugeri IRCCS - Institute of Montescano (Pavia) https://orcid.org/0000-0002-5331-1393

DOI: https://doi.org/10.4081/mrm.2023.936

Keywords:

costs, COPD, chronic respiratory illness

Abstract

Background: The use of case-based reimbursement for medical rehabilitation is greatly discussed. The investigators explored the relationship between disability and reimbursement opportunities in individuals with respiratory diseases undergoing in-hospital pulmonary rehabilitation (PR), considering the correlation (if any) between the Rehabilitation Complexity Scale (RCS-E v13) scores used at admission and the actual reimbursement.
Methods: This study is part of a larger prospective multicenter study conducted by eight Pulmonary Rehabilitation Units in Italy. Here, investigators considered only data from the Lombardy Region. On January 30^th or February 28^th, 2023, participants were allocated according to the main DRG into 4 groups [tracheostomized/ventilated (TX/V), chronic respiratory failure (CRF), COPD, and miscellaneous group]. We recorded anthropometrics, diagnosis, international outcome measures, and calculated admission and discharge RCS-E v13 scores and hospital stay reimbursement according to the healthcare system (HS).
Results: Three hundred and sixteen participants were evaluated. Patients were elderly, in the majority of cases with CRF, presenting comorbidities, disability, dyspnea, and reduced effort tolerance. At admission, RCS-E v13 showed an average moderate value of complexity. The median (IQR) HS reimbursement/stay was different among groups. RCS-E v13 evaluated at admission was weakly (r=0.3471), but significantly related to the HS reimbursement/stay (p<0.0001) mainly due to TX/V and miscellaneous subgroups, while no relationship was found for COPD and CRF patients. After PR, all outcome measures improved significantly in all groups (p<0.001 for all). Higher RCS-E v13 scores at admission did not correspond to a proper amount of reimbursement, being this latter under- or overestimated if compared to needs assessed by RCS-E v13. RCS-E v13 at discharge decreased for all subgroups (range -6 to -11) reaching a low value of complexity.
Conclusions: The RCS-E v13 disability score does not fully mirror the HS reimbursement for patients undergoing in-hospital PR.

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