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Q: Could you tell us your thoughts on the year-end Medicare bill the president signed effectively killing the “75% Rule,” locking levels at 60% instead?

A: The study we did [released in October, favoring inpatient rehabilitation facilities over skilled nursing facility therapy] certainly prompted the attention and got the review of Congress. Whether it was complete or perfect, the answer is no, but it certainly helped.

Q: Shouldn't skilled nursing facilities be upset at getting more competition for certain patients?

A: SNFs did get an initial benefit since the (75% Rule's) progression first said 50% of patients at IRFs had to be from 13 categories (or conditions) and now says 60%. They're not complete losers in that. 

Q: Wasn't the Centers for Medicare & Medicaid Services on SNFs' side on this?

A: Most of that [July 2007] commentary centered around hips and knees. Now, since it's been legislatively dealt with, CMS can't come out and regulatorily change it. Maybe not all of those with single joint problems can come to an IRF, but that doesn't mean that none of them should.

Q: Is it fair to call this just another win for the extremely powerful hospital lobby?

A: The IRF community and their subset of hospital associations started early, pushed bills through the Senate and House and got well over a majority of both sides of Congress. They were much better organized in the approach, so that did help IRF efforts in the end stages.

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