HARRISBURG — Fewer patients are being treated at Pennsylvania's rehabilitation hospitals and long-term acute care hospitals because of changes in Medicare eligibility and reimbursement rates, according to a state report being released today.

Both types of facilities must comply with certain restrictions on the patients they can treat in order to qualify for higher Medicare reimbursement rates, the Pennsylvania Health Care Cost Containment Council found.

About 52,000 patients were discharged from the state's 21 rehabilitation hospitals in the 2007 fiscal year — a 28 percent decline over five years, according to the council's annual report on the finances of facilities that provide specialized hospital care.

The trend is linked primarily to the phase-in of a federal rule that requires 60 percent of all patients at rehabilitation hospitals to be treated for one or more of 13 specific conditions, including stroke, brain injury and amputation, the council said. Facilities that do not comply are reimbursed at a lower Medicare rate for general hospitals. Rehabilitation hospitals derived more than half of their revenue statewide from Medicare reimbursements in 2007.

At Pennsylvania's 25 long-term acute care hospitals, which care for people with complex medical conditions, discharges of Medicare patients fell 6 percent, to 7,768, between the 2006 and 2007 fiscal years.

Medicare reimbursements accounted for more than two-thirds of the facilities' revenue in 2007. The patient decline was largely responsible for their operating profit margins declining by less than 1 percentage point over the same period, the council said.

The council attributed the drop in patients to the phase-in of a federal rule that limits the percentage of Medicare patients who can be admitted to a long-term acute care hospital from a single general hospital. The facilities must adhere to this rule to qualify for a higher Medicare reimbursement. It is too soon tell what implications the Medicare rule changes would have for patients, council spokesman Joe Martin said.

Outpatient surgery centers still account for the largest number of specialized health care facilities. Seventeen outpatient centers opened between June 2007 and May 2008, bringing the statewide total to 245, the council said.

The centers' total profit margins also rose to 25 percent in the 2007 fiscal year, up from 21 percent the previous year.

That rapid growth, coupled with the economic downturn, is increasing the financial strain on general hospitals, said Carolyn Scanlan, president and chief executive officer of the Hospital & Healthsystem Association of Pennsylvania.