Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care

Abstract

The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.

Some But Not Too Much: Multiparticipant Therapy and Positive Patient Outcomes in Skilled Nursing Facilities

“…Occupational therapy treatment in SNFs emphasizes independence in self-care tasks and may not directly impact the mobility tasks measured in this study. Research using new outcome measures from assessment items introduced in SNFs in late 2018, which incorporate both self-care and mobility tasks, may allow for a more sensitive understanding of the impact of OT treatment on self-care function in SNFs 40,41. For the sensitivity analysis examining community discharge, multiparticipant PT was a larger contributor to differences in community discharge rates than multiparticipant OT.…”

“…Research using new outcome measures from assessment items introduced in SNFs in late 2018, which incorporate both self-care and mobility tasks, may allow for a more sensitive understanding of the impact of OT treatment on self-care function in SNFs. 40,41 For the sensitivity analysis examining community discharge, multiparticipant PT was a larger contributor to differences in community discharge rates than multiparticipant OT. Similar to the potential explanation that more therapy is provided for patients with worse discharge potential as discussed earlier, it may be that the self-care skills needed for successful community discharge addressed by OT require more individualization according to the patient discharge environment, while improving physical function necessary for safety and mobility in the home setting is more easily addressed through group exercises delivered by PTs.…”

Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy

“…Legislation passed by Congress put the gears in motion for CMS to develop the procedures now being implemented to measure and improve the quality of services provided. As discussed by Kroll and Fisher (2018) and Giles, Edwards, Morrison, Baum, and Wolf (2017), the purpose of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185) was to evaluate and better align the incentives and payment for PAC services provided under Medicare and to optimize the quality of services in PAC settings.…”