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  • Preoperative Physical Therapy Results in 'Significant' Reduction in Postoperative Care Use for Patients Undergoing Hip or Knee Replacement

    A new study has found that as few as 1 to 2 sessions of preoperative physical therapy can reduce postoperative care use by 29% for patients undergoing total hip or knee replacement, adding up to health care cost savings of more than $1,000 per individual.

    Researchers in Ohio reviewed 4,733 Medicare cases involving total hip or knee replacement from a combination of 169 rural and urban hospitals with wide geographic distribution, and found that 79.7% percent of patients who did not receive preoperative physical therapy required postacute care services. That rate dropped to 54.2% for patients who received even a small number of physical therapy sessions before surgery. The study was e-published ahead of print in the Journal of Bone and Joint Surgery (abstract only available for free).

    After adjusting for demographic variables and comorbidities, the study's authors estimated a 29% reduction in postoperative care use among the preoperative physical therapy group, which translated into adjusted cost reductions of $1,215 "driven largely by reduced payments for skilled nursing facility and home health agency care."

    Patients with at least 1 billed encounter using CPT codes designating physical therapy evaluation or self-care/home management training were included in the preoperative group, providing they had received the service within 30 days of their surgeries.

    Researchers believe that the benefit of preoperative physical therapy was derived mostly from the way it prepared patients for postoperative rehabilitation. In most instances studied, they write, preoperative physical therapy was limited to 1 or 2 sessions, which "suggests that the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple intensive training sessions to develop strength and range of motion."

    "Our study demonstrates a significant reduction in postacute care use associated with the use of physical therapy during the preoperative period for total joint replacement surgery," authors write, adding that in settings where replacement surgery has been recommended by an orthopedic surgeon, "physical therapy appears to provide value within the structure of a standardized preoperative joint replacement education and planning program in which physical therapists may play an important role."

    While researchers acknowledge that more work needs to be done to pinpoint the best way to balance resource allocation between pre- and postoperative activities, they cite the current study's findings as a good first step in refining new models of care.

    "As payments in health care move from a fee-for-service basis to more global payments that require some risk sharing by providers," authors write, "the ability to manage populations across the continuum to high-quality outcomes at low cost will be imperative."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website where you can find a clinical summary on total knee arthroplasty that includes information on perioperative care.

    State Policy and Payment Forum Delivers On-Target Advocacy Information

    This year's State Policy and Payment Forum in Seattle, Washington, once again informed and recharged physical therapists (PTs), physical therapist assistants, and physical therapy students from across the country to help them continue to advocate for the physical therapy profession at the state level.

    Cohosted by APTA and the Washington Chapter, the 2014 forum gave more than 200 attendees the opportunity to learn from influential public policy makers and other physical therapy advocates, collaborate with colleagues in developing and improving their components' state advocacy efforts, and network with other professionals. Topics included fair physical therapy copay legislation, a debate on the merits of “any willing provider” legislation, issues surrounding network adequacy, emerging scope of practice issues, PTs' ordering of x-rays and imaging studies, dry needling, state licensure issues, and more.

    The forum's luncheon keynote speaker was Mark McClellan, MD, PhD, a senior fellow and director of the Health Care Innovation and Value Initiative at the Brookings Institution. A former administrator of the Centers for Medicare and Medicaid Services and former commissioner of the US Food and Drug Administration, McClellan focuses his current work on promoting quality and value in patient-centered health care.

    Be sure to check out the Storify with video highlights from this year’s APTA State Policy Forum. And don't miss next year's event scheduled for September 12-14, 2015, in Denver, Colorado.