Rehabilitation Services After the Implementation of the Nursing Home Prospective Payment System

Murray, Patrick; Love, Thomas E.; Dawson, Neal V.; Thomas, Charles L.; Cebul, Randall D.

doi:10.1097/01.mlr.0000182490.09539.1e

Cited by 20 publications

(20 citation statements)

References 25 publications

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“…The prospective payment system and diagnosis related groups for acute hospitals and the post-acute sector led to shorter hospital lengths of stay with subsequent increases in post-acute care health utilization and costs during the 1990s 19, 20, 33, 34. While the numbers of patients with medical illnesses receiving post-acute physical, occupational, or speech services has increased in skilled nursing facilities, rehabilitation hospitals, and long-term care hospitals, the amount of rehabilitation received by patients has decreased in some settings and remains of short duration (<1 month) 19, 20, 35-37. Little is known about the functional consequences of these utilization changes to older medical patients, or the best way to cost-effectively deliver high quality care that maximizes functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Current rehabilitative utilization patterns suggest that many medical patients with functional decline are not receiving the most aggressive short-term intervention available. Possible explanations include inability to meet functional requirements or the requirement that 75% of admissions to inpatient rehabilitation facilities be for specific categorical diagnoses 19, 20, 35-37. It is not known who with medical illness is most likely to benefit from acute rehabilitation, or whether care through home care, skilled nursing facilities, or rehabilitation hospitals would be most likely to improve outcomes 44, 45.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

Boyd

Landefeld

Counsell

et al. 2008

J American Geriatrics Society

600

481

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OBJECTIVES-To describe functional outcomes in the year following discharge for elders discharged from the hospital after an acute medical illness with a new or additional disability in Dr. Boyd conceptualized this paper, obtained funding, developed the design of the analysis with Drs. Covinsky and wrote this manuscript. Dr. Landefeld was responsible for collaborating in the following activities for this paper: study design and implementation, obtainment of funding, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Counsell was responsible for collaborating in the following activities for this paper: study design and implementation, obtainment of funding, analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Palmer was a co-investigator responsible for collaborating in the following activities for this paper: design and implementation, interpretation of data, and critical revision of the manuscript for important intellectual content. Dr. Fortinsky was a co-investigator responsible for collaborating in the following activities for this paper: the analysis and interpretation of data and critical revision of the manuscript for important intellectual content. Dr. Kresevic was a co-investigator responsible for collaborating in the following activities for this paper: design and implementation, interpretation of data, and critical revision of the manuscript for important intellectual content. Dr. Covinsky was responsible for supervision of the entire project and manuscript, and collaborated on the design and implementation, analysis and interpretation of data, and undertook critical revision of this manuscript for important intellectual content. Sponsors' Role:The funding sources had no role in the design and conduct of the study, collection, management, analysis or interpretation of the data, the preparation, review or approval of the manuscript. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript their basic self-care activities of daily living(ADL)(compared to their preadmission baseline two weeks before admission), compared to elders discharged with baseline ADL function, and identify predictors of failure to recover to baseline function one year after discharge. DESIGN-Observational Study SETTING-Tertiary care hospital, Community teaching hospitalPARTICIPANTS-Older(≥70 years) patients non-electively admitted to general medical services (1993)(1994)(1995)(1996)(1997)(1998).MEASUREMENTS-Number of ADL disabilities 1,3,6,&12 months after discharge compared to pre-admission baseline. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each timepoint.RESULTS-By 12 months after discharge, among those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at their baseline function. Among those discharged with baseline fun...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

Boyd

Landefeld

Counsell

et al. 2008

J American Geriatrics Society

600

481

View full text Add to dashboard Cite

show abstract

“…Interestingly, this resulted in a greater number of patients receiving rehabilitation therapy, but a general decrease in the amount of therapy given in hours per week. However, nursing home patients with medical diagnoses including MS received more care [15] . Also, in 1996, the immunomodulatory drugs interferon-␤ 1a and glatiramer acetate were approved by the FDA as subcutaneous injections, providing more out-of-hospital treatment options [16] .…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Trends in Hospitalization for Multiple Sclerosis

Lad

Chapman²,

Vaninetti³

et al. 2010

Neuroepidemiology

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Objectives: Multiple sclerosis (MS) is a neurological disorder with a high burden on patient quality of life and medical rehabilitation services. Little is known about the acute hospitalization costs and characteristics. We examined the trends in MS hospitalizations from 1993 to 2006. Methods: The Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was searched using the ICD-9 code 340 (MS). Diagnostic, treatment and administrative data were analyzed using basic statistical software. Results: A total of 288,454 hospital admissions with the primary diagnosis of MS occurred between 1993 and 2006, an average of 20,604 admissions annually. The percentage admitted from the emergency department (ED) increased from 19.4 to 60.0% during 1993–2006. The mean cost for each inpatient increased from USD 7,965 to 20,076. The percentage of discharges to home health care increased from 8.6 to 14.9%, and the percentage of discharges to nursing homes and rehabilitation services increased from 8.3 to 22.6%. In 2006, Medicaid patients were significantly more likely to be admitted from the ED (p < 0.001). Medicare payers were significantly more likely to be discharged to a nursing home/rehabilitation (p < 0.0001). Conclusion: National health insurance policies have made measurable effects on MS disease management. MS is becoming more expensive to treat acutely, and improved treatment modalities geared toward decreasing acute flare-ups may provide substantial cost savings by reducing ED visits, inpatient hospitalizations and the need for rehabilitation.

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“…7,21 Murray et al 21 found that the proportion of people receiving therapy increased between 1994-1996 and 2001, but the hours of therapy decreased slightly. This finding was condition specific, as people with medical conditions received the largest increase in rehabilitation services and those with stroke experienced the greatest decline.…”

Section: Discussionmentioning

confidence: 99%

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham

Jette

Ngo

et al. 2008

Archives of Physical Medicine and Rehabilitation

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Objective-To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design-Data from the nationally representative Medicare Current Beneficiary Survey (MCBS)were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings-Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants-Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions-Not applicable.Main Outcome Measures-Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results-Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This article uses a nationally representative database to analyze the use of 2 PAC servicesphysical (PT) and occupational therapy (OT)-by Medicare beneficiaries with five common diagnoses across various settings of care before and after the 1997 BBA. Looking simultaneously at service use across different rehabilitation settings is important because changes in 1 sector could alter care patterns in another setting. Additionally, exploring changes in service use is complicated by differing timeframes for implementing BBAmandated prospective payment across PAC settings (fig 1). For instance, the BBA created an interim payment system for home health agencies, which was phased in over 12 months beginning October 1, 1997, and controlled both average spending per visit and per Medicare beneficiary; full home health agency prospective payment was implemented in October 2000. A prospective payment system (PPS) was implemented for SNFs in July 1998, and in January 2002 for IRFs. For outpatient therapy, the BBA imposed 2 annual $1500 caps-one for PT...

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Rehabilitation Services After the Implementation of the Nursing Home Prospective Payment System

Cited by 20 publications

References 25 publications

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

Socioeconomic Trends in Hospitalization for Multiple Sclerosis

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

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