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 The Path Home May Lead Through Extra Therapy, Study Finds

Skilled nursing therapy may cost money, but more than ever before, it’s helping people get home, a new study claims.
In what may be the first study of its kind, researchers from Cornell, Brown, and Harvard examined the cases of nearly 482,000 Medicare patients who were released from hospitals into skilled nursing centers after breaking their hips between 2000 and 2009. They found that extra therapy  improved patients’ odds of getting straight home. For every hour of extra therapy per week, a patient’s chance of being discharged to home increased by more than 3 percent, the researchers say.
The study, published in the January issue of Physical Therapy—the peer-reviewed journal of the American Physical Therapy Association—comes as regulators and some legislators are increasingly nervous about the rising costs of skilled nursing services, and whether some skilled nursing companies are more focused on their profits than on their patients. The Medicare Payment Advisory Commission meets in Washington this week, for instance, and is likely to continue its recommendations that regulators target skilled nursing’s Medicare rates for a reduction in the amount of therapy the government will pay for.
The researchers here, led by Cornell professor Hye-Young Jung, found that while costs have, indeed, risen dramatically since 2000, the average length of stay has leveled off, and the ability of skilled nursing centers to get people straight to home has also improved dramatically.
Outcomes Improved
In 2000, Medicare patients had a 71 percent chance of going straight home after rehabbing their hips in skilled nursing centers. By 2009, the chances had improved to 79 percent, Jung and colleagues say.
“Our findings suggest that increasing the number of hours of therapy improves outcomes for these patients, as reflected in the increased likelihood of being discharged to home,” Jung writes for the team. “The results of our secondary analysis indicated that this relationship was true for both occupational therapy and physical therapy.”
Indeed, at least one additional hour of occupational therapy per week improved a patient’s chances of going straight home by more than 5 percent, and an additional hour or more of physical therapy improved a patient’s chances of going straight home by nearly 6 percent, Jung says.
Value, Not Cost
The exception appears to be those hip fracture patients who suffered the worst impairments and therefore had the lowest chances of getting home in the first place, Jung and colleagues found. Nonetheless, the research team is hopeful that legislators and policymakers will remember that the latest Washington vogue for “value-based purchasing” is about “value,” not price.
“As providers are increasingly incentivized to reduce costs through bundled payment initiatives, Accountable Care Organizations, and other policy measures, reductions in rehabilitative therapy provided by SNFs may be targeted,” Jung writes, referring to skilled nursing facilities. “Efforts to lower Medicare spending on post-acute care services must be careful to avoid reducing therapy services that promote successful discharge.”
Jung’s findings are music to the ears of Dan Ciolek, the asociate vice president of therapy advocacy for the American Health Care Association/National Center for Assisted Living. For more than two years, Ciolek and his colleagues have been pushing back against what they see as arbitrary cuts to therapy services that are focused solely on cost, not on value. 
“We agree 100 percent with the study’s conclusion that payment policy reforms shouldn’t create disincentives to provide the intensity of therapy necessary to patients who are likely to benefit from it,” he tells Provider. “There are better ways to ensure that patients get the right care, at the right place, and at the right time."
Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.
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