From 1991 to 1996, researchers at the University of Colorado Health Sciences Center compared outcomes among elderly patients in two types of health care settings:
- Integrated fee-for-service (FFS) health care systems that offered rehabilitation services in inpatient rehabilitation hospitals and skilled nursing facilities (SNFs).
- Large HMOs that primarily relied on owned or contracted subacute skilled nursing facilities for Medicare rehabilitation services. (Subacute skilled nursing facilities are designed as an intermediate option between traditional skilled nursing facilities and the higher-intensity inpatient rehabilitation hospitals.)
HMO patients were more likely to receive rehabilitation treatment in subacute SNFs, which provided more intense rehabilitation than regular skilled nursing facilities but less intense rehabilitation than rehabilitation hospitals.
There were no differences in one-year outcomes between hip fracture patients treated in fee-for-service and HMO settings.
Stroke patients treated in FFS settings, however, improved more in function during the rehabilitation episode and were less likely to be placed in nursing homes than those treated in HMO settings.