Use of Physical and Occupational Therapy by Medicare Beneficiaries Within Five Conditions
| العنوان: | Use of Physical and Occupational Therapy by Medicare Beneficiaries Within Five Conditions |
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| المؤلفون: | Long Ngo, Nancy K. Latham, Jane Soukup, Alan M. Jette, Lisa I. Iezzoni |
| المصدر: | American Journal of Physical Medicine & Rehabilitation. 88:308-321 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2009. |
| سنة النشر: | 2009 |
| مصطلحات موضوعية: | Occupational therapy, Service (business), medicine.medical_specialty, Activities of daily living, Rehabilitation, business.industry, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, medicine.disease, Family medicine, Acute care, medicine, Medical emergency, Prospective payment system, Medicare Payment Advisory Commission, business, Reimbursement |
| الوصف: | Although critics often raise concerns about Medicare's acute care focus, 1, 2 the program also covers substantial services beyond acute care, including rehabilitation therapy in inpatient rehabilitation hospitals, skilled nursing facilities, hospital outpatient departments, private therapists’ offices, and patients’ homes. Lumped broadly under the phrase “post-acute care,” Medicare costs for such services grew rapidly, especially after adoption of prospective payment for acute care hospitalizations. 3-7 To slow and contain these rising Medicare costs, the 1997 Balanced Budget Act (BBA) introduced prospective payment for post-acute care, phasing in these systems in different settings across several years. 4, 7-11 Since then, governmental agencies (e.g., the Medicare Payment Advisory Commission or MedPAC) and researchers have examined how BBA's payment policy changes have affected post-acute care service use and expenditures. 3, 5, 9, 11-19 Early draconian drops in home health care prompted Congress to pass the 1999 Balance Budget Refinement Act (BBRA), which eased certain BBA payment provisions. Congress worried that some persons who needed post-acute care no longer had access to these services. Studies of recent trends in rehabilitation therapy use by Medicare beneficiaries have generally relied on information with limited clinical content, notably reimbursement claims. 11, 20 Claims-based analyses provide excellent information about the volume and costs of covered services. However, claims analyses offer little insight into whether service patterns have changed for persons with strong clinical indications for rehabilitation services. In other words, has service intensity changed over time for patients who likely need these services? This study explored use of physical and occupational therapy (PT and OT) between 1994 and 2001 using data from the Medicare Current Beneficiary Survey (MCBS). MCBS data include respondents’ self reports of various diagnoses, functional impairments, and activities of daily living (ADL) limitations; MCBS files also include the amount of services used with and without Medicare reimbursement. We examined therapy patterns within five conditions that often could benefit from PT and/or OT: new (incident) stroke; new (incident) acute myocardial infarction (AMI); chronic obstructive pulmonary disease (COPD); arthritis or degenerative joint disease (DJD); and lower extremity mobility problems, regardless of cause. These five conditions represent three broad clinical indications for PT and/or OT: acute events with potentially chronic, debilitating consequences (stroke and AMI); chronic, progressive conditions with potentially acute exacerbations (arthritis/DJD and COPD); and a functional impairment representing a “final common pathway” for many debilitating diseases, regardless of etiology (lower extremity mobility problems). This research was part of a larger study looking at outcomes of PT and OT provided in community settings. Given its policy and practical importance, we took advantage of our longitudinal data set to examine trends of service use immediately before and after passage of the BBA. An earlier publication used cross-sectional analyses of MCBS data from 1995, 1999, and 2001 to explore patterns of PT and OT use in different settings of care (inpatient rehabilitation facility, skilled nursing facility, home health agency, and outpatient settings).7 The analyses presented here use the complete longitudinal data file (1994-2001) and sophisticated mathematical modeling methods to explore three primary research questions: (1) What proportion of persons with these clinical indications for PT and/or OT received services from 1994 through 2001? (2) How did their service intensity (i.e., units of services used) vary from 1994 through 2001? (3) Did service intensity vary by patients’ demographic characteristics (e.g., were there disparities in care by gender or race/ethnicity)? We hypothesized that the proportion of persons receiving these services – and the intensity of service use – would decline in the years following the BBA passage as new prospective payment systems were implemented. We also hypothesized that certain subsets of patients, such as those with low incomes, less education, and racial and ethnic minorities, would be less likely to receive PT and/or OT services. |
| تدمد: | 0894-9115 1994-2001 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::d21feb57b4df498d8a54b10eede735f3 https://doi.org/10.1097/phm.0b013e318198a791 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi...........d21feb57b4df498d8a54b10eede735f3 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 08949115 19942001 |
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