Nursing Home Physical Therapy Utilization Statistics

Exploring Changes and Trends in Nursing Home Physical Therapy

With the implementation of the Patient Driven Payment Model (PDPM) in October 2019, the landscape of physical therapy in nursing homes has experienced significant shifts. This article delves into the statistics that illustrate these changes and provides insights into how therapy services have been impacted by healthcare policy adjustments.

Understanding the Impact of PDPM on Therapy Utilization

When did the Patient Driven Payment Model (PDPM) go into effect?

The Patient Driven Payment Model (PDPM) went into effect on October 1, 2019. This transformative model was finalized by the Centers for Medicare & Medicaid Services (CMS) in July 2018 and marked a pivotal change in how skilled nursing facilities (SNFs) are reimbursed. Unlike its predecessor, the RUG-IV model, PDPM bases reimbursements on the clinical and functional characteristics of patients rather than the volume of services provided. This shift aims to better align payment with patient care needs, facilitating a more effective allocation of resources.

Changes in therapy utilization post-PDPM

Following the implementation of PDPM, therapy utilization patterns revealed notable shifts. A comprehensive study conducted across 121 skilled nursing facilities in Oregon analyzed 35,540 short stays and found a 19.3% decrease in individual occupational therapy (OT) minutes and a 19.0% decrease in individual physical therapy (PT) minutes per week within the first five months. Conversely, group therapy sessions experienced slight increases, with group OT and PT minutes rising by an average of 1.67 and 1.77 minutes per week respectively. This indicates a potential shift in therapeutic approaches, focusing less on individual sessions and more on group-based care.

Impacts on patient discharge and readmission rates

Interestingly, despite the significant alterations in therapy minutes utilized, the study observed no statistically significant changes in patient outcomes such as the length of stay in SNFs, rates of discharge to the community, or readmission rates within 30 days post-discharge. This suggests that while the therapy approach has shifted under PDPM, other critical metrics regarding patient discharge and healthcare efficiency have remained stable, emphasizing the importance of adapting therapy practices to better meet patient needs without negatively impacting overall care outcomes.

Trends in Therapy Utilization: Statistical Insights Post-PDPM

Decrease in Individual Therapy Minutes

Following the implementation of the Patient Driven Payment Model (PDPM) in October 2019, significant shifts were observed in therapy provision within skilled nursing facilities (SNFs). Notably, individual occupational therapy (OT) and physical therapy (PT) minutes dropped considerably. Data from a study examining 35,540 short stays show a decrease of 19.3% for OT and 19.0% for PT. This pattern suggests a marked departure from prior practices where the emphasis was on maximizing therapy minutes to boost reimbursement.

Increase in Group Therapy Sessions

In contrast to the decline in individual therapy minutes, group therapy sessions for both OT and PT experienced a slight uptick. On average, group OT increased by 1.67 minutes per week, while group PT saw an increase of 1.77 minutes. This indicates a shift toward a more collaborative and potentially cost-effective therapeutic approach in skilled nursing environments.

Overall Statistical Analysis of Therapy Use Post October 2019

An analysis of therapy utilization post-PDPM reveals crucial aspects:

These trends underscore the evolving landscape of rehabilitation services under Medicare, showcasing a balanced approach to patient therapy needs.

Historical and Contemporary Utilization Patterns in Therapy Services

RUG Category Trends Before PDPM

Prior to the implementation of the Patient Driven Payment Model (PDPM) in October 2019, there was a significant trend in the utilization of therapy services within skilled nursing facilities (SNFs). From Fiscal Year (FY) 2011 to FY 2013, the percentage of billed days under the Ultra-High Rehabilitation (RU) Resource Utilization Group (RUG) category saw a notable increase—from 44.8% to over 50%. This rise indicated an increasing dependence on higher intensity therapy classifications.

Effects of Therapy Hours on Discharge Outcomes

Multiple studies have highlighted the relationship between therapy hours and patient outcomes. For instance, an additional hour of therapy per week was linked to a 3.1-percentage-point increase in the likelihood of a patient being discharged to their home. While increased therapy generally leads to better outcomes for many patients, those within the higher RUG categories sometimes did not experience similar benefits from additional therapy hours.

Resource Utilization Statistics in Nursing Homes

In 2013, skilled nursing facilities reported over $27 billion in Medicare payments. A substantial portion of this was allocated to the ultra-high RUGs, which required a minimum of 720 minutes of therapy. As payment structures changed, the patterns observed indicated a dramatic shift towards higher intensity therapy, with over half of very-high therapy claims stopping just short of the required thresholds, suggesting potential inefficiencies within the system.

Efficacy and Quality of Care in Physical Therapy Services

Links between therapy services and patient outcomes

Therapy services play a crucial role in patient recovery in skilled nursing facilities (SNFs). Studies indicate that an additional hour of therapy per week correlates with a 3.1-percentage-point increase in the likelihood of patients being discharged to their homes. However, the relationship can vary; those in the ultra-high rehabilitation category may not see as much benefit from increased therapy compared to other patient groups.

Challenges faced by specific patient populations

Certain populations, especially those with complex medical needs or pain conditions, often encounter significant barriers to receiving adequate therapy. For example, only 12.1% of physical therapy episodes directly addressed spine pain, despite nearly half of long-term care residents experiencing such discomfort. Additionally, access disparities were noted among racial and ethnic groups, as well as individuals with dementia and depression, limiting their chances of receiving needed PT services.

Disparities in therapy service access

The availability and utilization of therapy services highlight ongoing disparities in care. For instance, 49.6% of long-term care residents received physical therapy, yet many did not receive appropriate interventions tailored to their specific needs. This gap may reflect systemic issues in healthcare provision, impacting the overall quality of care in SNFs.

Comprehensive Overview of Nursing Home Physical Therapy Services

Do nursing homes provide physical therapy?

Yes, nursing homes provide physical therapy as part of their rehabilitation programs. Residents typically receive one to two hours of rehab each day, which might include physical, occupational, and speech therapy delivered by on-site specialists. This level of care is essential for residents needing support for recovery and functional improvement after hospital stays or surgeries.

However, it's important to note that nursing homes do not offer rehabilitation services with the same intensity as hospital inpatient rehabilitation centers, which usually provide three to four hours of therapy daily. The frequency of access to doctors in hospital settings also tends to be greater, which can positively influence patient recovery outcomes.

Intensity of rehabilitation programs in different settings

The intensity of rehabilitation varies significantly between settings. In nursing homes, physical therapy sessions are generally less intense compared to inpatient rehab facilities where more hours of therapy are typical. For example, while patients in nursing homes may receive 60 to 120 minutes of therapy a day, those in inpatient rehab may have multiple sessions totaling several hours.

Medicare coverage for nursing home rehab services

Medicare may cover the costs of these rehabilitation services in nursing homes, provided certain criteria are met, such as having a qualifying hospital stay. This coverage is vital for many patients as it helps facilitate access to necessary rehabilitation care following acute medical events.

Concluding Thoughts on Nursing Home Therapy Services

The shift to the Patient Driven Payment Model has undeniably altered the landscape of physical therapy services in nursing homes. While therapy minutes have generally decreased, the quality of care and patient outcomes have become areas of increasing importance. Understanding these trends helps inform policy adjustments and ensures that skilled nursing facilities can deliver optimal rehabilitation services under evolving healthcare regulations.

References

• Changes in Therapy Utilization at Skilled Nursing Facilities Under ...
• [PDF] Observations on Therapy Utilization Trends - CMS
• Changes in Therapy Utilization at Skilled Nursing Facilities Under ...
• Does More Therapy in Skilled Nursing Facilities Lead to Better ...
• Utilization and Potential Disparities in Access to Physical Therapy ...
• [PDF] Patterns of Post-Acute Utilization in Rural and Urban Communities
• Changes in Therapy Utilization at Skilled Nursing Facilities Under ...