The health care revolution: a catalyst for professional evolution.

T he current revolution in rhe delivery of healrh care services in the United States has been marked by a moving away from a feefor-service health care payment sysrem to a managed care system of reimbursement. Historically, there has not been a direct link between those responsible for rhe financing of health care services and those who provide rhe services. Managed care integrates borh rhe control of financing services and how services are delivered. Nowhere is this more cJearly demonsrrared than in the recent changes in Medicare's approach to reimbursement for rehabilitation services provided ar the skilled nursing facilicy (SNF) level of care. Beginning]uly I, 1998, Medicare will no longer reimburse an SNF on the basis of the facilicy's COStS for providing occupational therapy and other services (Balanced Budget Act, 1997, Public Law 105-33). Instead, payment for rehabilitation will be made prospectively on the basis of the patients' therapy needs as defined by their classifIcation into one of five rehabilitation categories. These categories are derived from the rehabilitation utilization groups-version III (RUGs-III) classification system. The RUGs-III classification system generally can be compared with the diagnosis-related groups reimbursement system presently used by the Health Care Financing Administration (HCFA) to cJassify patients receiving acute care. That is, this prospective payment system (PPS) wjJl be used to control the costs of rehabilitation services provided in SNFs in the same manner that the hospital PPS controls Mary Foto