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

To the Editor. —In their study examining the outcomes of stroke patients in Medicare fee-for-service (FFS) and managed care systems, Dr Retchin and colleagues neglected to mention the potential of skilled nursing facilities in the rehabilitation of stroke patients. Many nursing homes provide excellent rehabilitation with a multidisciplinary team approach, which allows patients who are frail after stroke and have multiple comorbidities to improve their functional status at a less intense rate than would be expected on an acute care unit. Future research needs to focus on how functional improvement and quality of life are affected by rehabilitation therapy, regardless of setting.