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A first-of-its-kind study shows that physical therapy and occupational therapy provide functional benefits to most patients in postacute care settings, with evidence of significant rehabilitative value across 1.4 million Medicare cases.

This research used data that the Centers for Medicare & Medicaid Services made available for the first time. The findings have implications for postacute care payment system reforms and can serve as a baseline for future studies.

"This innovative 'Therapy Outcomes in Post-Acute Care Settings' study shows that occupational therapy and physical therapy have direct and positive impacts on patients in postacute care settings, including improving the functional ability of patients and reducing readmissions to acute care hospitals," said Wendy C. Hildenbrand, PhD, MPH, OTR/L, president of the American Occupational Therapy Association. "Most important, the study's findings indicate that patients who receive occupational therapy and physical therapy during their initial postacute care episode are more likely to have better outcomes, including a better quality of life and increased meaningful participation in everyday living."

The study — also called TOPS — has implications for the Centers for Medicare & Medicaid Services' ongoing implementation of postacute care payment system reforms, as well as the development of any future unified prospective payment system. "The findings of the TOPS study imply that CMS should move carefully and thoroughly when researching and developing a unified PAC prospective payment system, a system that may disadvantage patients with high rehabilitation needs," said American Physical Therapy Association President Sharon Dunn, PT, PhD. "CMS must take care to monitor the level of therapy provided in PAC settings, in case new payment incentives inadvertently or negatively impact the therapeutic benefit provided to Medicare beneficiaries, or diminish the therapy services and approaches distinct to each PAC setting."

APTA and AOTA jointly commissioned Dobson DaVanzo and Associates to examine the relationship between therapy intensity (treatment amount per case), patient functional status, and readmissions (outcomes) in multiple postacute care settings, including inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. Medicare administrative claims and functional assessment data were studied to measure therapy utilization and the reported need for assistance with core activities of daily living, including self-care and mobility, at the start and end of a postacute care stay following patient discharge from an acute hospital. The study examined data collected from January 2015 through December 2016.

Key findings of the TOPS study include:

  • Physical therapy and occupational therapy provided a functional benefit to most patients, with evidence of significant rehabilitative value across 1.4 million Medicare cases.
  • TOPS detected positive value in physical therapy and occupational therapy provided in PAC settings for rehabilitating and preventing the decline of core ADL function in beneficiaries.
  • Increased therapy intensity is positively correlated with increases in measured functional status in patients within the PAC settings studied following discharge from initial hospitalization.
  • Thirty-day readmission rates to acute care hospitals following a PAC episode decreased after therapy and appear to have varying threshold effects within each setting. Readmission rates help to reflect whether patients are receiving appropriate levels of care following discharge from the hospital, and these findings indicate that patients who receive physical and occupational therapies during their initial PAC episode are less likely to be readmitted and more likely have better outcomes, such as survival, functional ability, quality of life, and participation in daily living.

The TOPS study suggests that therapy is well-targeted to the differing clinical needs and treatment goals of the populations served within each PAC setting as patients move through the recovery process. Although the PAC settings studied may have some overlap of patients, each setting serves a generally different patient population, in terms of their acuity and their treatment goals.

Findings specific to each PAC setting include:

  • Intensive therapy stays within an inpatient rehab facility tended to demonstrate significant rehabilitation through measures of functional independence.
  • Residents in skilled nursing facilities demonstrated a positive relationship between therapy intensity and functional change. Some clinical conditions treated in those facilities showed clear increasing benefits from greater therapy, particularly joint replacement therapy.

Patients receiving home health services showed marginal improvements in predicted functional status score change that continuously increased with added therapy. This pattern held across the overall model and all subgroups.

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