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James R. Swenson, MD
American Academy of Physical Medicine and Rehabilitation Chicago, Ill

JAMA. 1997;278(16):1315.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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.^2,3

As 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 . . . [Full Text PDF of this Article]

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