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Patients recovering from stroke benefit from frequent, multi-disciplinary therapies in skilled nursing facilities (SNFs). As a major driver of spending, rehabilitation in SNFs is vulnerable to scrutiny from payers including Medicare. This review explored impacts of current payment programs (Patient Driven Payment Model, Bundled Payments for Care Improvement Advanced, Accountable Care Organizations, and Medicare Advantage) on access and outcomes of rehabilitation in SNFs after stroke.

There is minimal SNF payment research specific to stroke. For the general Medicare population, payment programs frequently reduced access to SNFs and rehabilitation services within SNFs, but utilization for patients with stroke was less impacted. Payment programs had mixed or no impact on mortality and hospital readmission after stroke.

Reductions in utilization of SNF …