In
a study evaluating the
financial impact of providing early physical therapy for intensive care
patients, researchers at Johns Hopkins found that the
up-front costs are outweighed by the financial savings generated by earlier
discharges from the intensive care unit (ICU) and shorter hospital stays
overall.
"The evidence is growing that
providing early physical and occupational therapy for intensive care patients—even
when they are on life support—leads to better outcomes," says Dale M.
Needham, MD, PhD, senior author of the study. "Patients are stronger and
more able to care for themselves when they are discharged."
Hospital administrators' concerns
about costs have been cited as barriers to implementing early rehab programs in
the ICU. "However, our study shows that a relatively low investment up
front can produce a significant overall reduction in the cost of hospital care
for these patients," Needham says. "Such programs are an example of
how we can save money and improve care at the same time."
For the study, the researchers
developed a financial model based on actual experience at The Johns Hopkins
Hospital's medical intensive care unit (MICU) and projections for hospitals of
different sizes with variable lengths of stay.
The Johns Hopkins MICU admits about
900 patients each year. In 2008, the hospital created an early rehabilitation
program with dedicated physical therapists and occupational therapists, which
added about $358,000 to the cost of care annually. However, by 2009, the length
of stay in the MICU had decreased an average of 23%, down from 6.5 days to 5 days,
while the time spent by those same patients as they transitioned to
less-intensive hospital units fell 18%. Using their financial model, the
authors estimated a net cost saving for the hospital of about $818,000 per
year, even after factoring in the up-front costs.
The researchers then analyzed the
potential impact of early rehabilitation services in 24 different scenarios,
accounting for variations in the number of ICU admissions, cost savings per day
and reductions in length of stay.
They
found that in 20 out of the 24 scenarios, hospitals would have an overall cost
savings by providing early rehabilitation to patients in the ICU, and in the 4
remaining scenarios, using the most conservative assumptions, there was a
modest net cost increase of up to $88,000 per year.
APTA member Michael
Friedman, PT, MBA, is a coauthor of the study.
APTA's
innovative models of care video series includes an interview with a physical
therapist who was instrumental in starting an early physical therapy program
for patients in a Houston hospital's ICU.