October 22, 1997

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

Author Affiliations

American Academy of Physical Medicine and Rehabilitation Chicago, Ill

JAMA. 1997;278(16):1315. doi:10.1001/jama.1997.03550160035018

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