​The American Physical Therapy Association (APTA) and American Occupational Therapy Association (AOTA) issued a Joint Statement on the results of a Dobson DaVanzo-commissioned study—Therapy Outcomes in Post-Acute Care Settings (TOPS)—that showed that most patients examined gained functional benefit from physical therapy (PT) and occupational therapy (OT).

Separately, in reviewing the report, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said the findings indicate positive ramifications for PT/OT reimbursement under the current fee-for-service and any future unified payment system. 

First, in the joint statement by the two therapy associations, Wendy Hildenbrand, PhD, president of AOTA, said the study helps make the point that OT and PT have direct and positive impacts on patients in post-acute care (PAC) settings, including improving the functional ability of patients and reducing readmissions to acute care hospitals.

“Most important, the study’s findings indicate that patients who receive occupational therapy and physical therapy during their initial post-acute care episode are more likely to have better outcomes, including a better quality of life and increased meaningful participation in everyday living,” the study said.

Key findings included:

• PT/OT provided a functional benefit to most patients, with evidence of significant rehabilitative value across 1.4 million Medicare cases.
• TOPS detected positive value in PT/OT provided in PAC settings for rehabilitating and preventing the decline of core function in activities of daily living for 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.
  

In its own summary of the report’s findings, AHCA/NCAL said that the stated purpose of the study was to examine the relationship between therapy intensity (treatment amount per case), patient functional status, and readmissions (outcomes) in multiple PAC settings, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs).

“Medicare Part A fee-for-service claims and functional assessment data (from the Minimum Data Set (MDS) in SNFs) 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 PAC stay following patient discharge from an acute hospital,” AHCA/NCAL said.

Dan Ciolek, AHCA associate vice president of therapy advocacy, said the general theme from the report and statements by the two therapy associations are that “PAC therapy produces positive outcomes and that current Medicare fee-for-service policy, as well as any potential future unified post-acute care (U-PAC), payment model should consider patient characteristics and not disincentivize appropriate therapy use.”  

In that vein, he noted that the recent proposed payment rule issued by the Centers for Medicare and Medicaid Services (CMS) indicated that last year’s implementation of the Patient Driven Payment Model (PDPM) and the changes that model made to therapy payment have not had an impact on health outcomes, as an example. 

In the “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022,” published in the Federal Register on April 15, CMS said it would “continue to monitor these and other metrics to identify any adverse trends that may have been caused by changes in care patterns that accompanied the implementation of PDPM.”

In the proposed rule, the agency said, “For example, we observed no changes in the percentage of stays with falls with major injury, the percentage of stays ending with Stage 2–4 or unstageable pressure ulcers or deep tissue injury, the percentage of stays readmitted to an inpatient hospital setting within 30 days of SNF discharge, or other similar metrics.”

Ciolek says AHCA supports “the thoughtful CMS efforts at monitoring PDPM implementation to assure that SNFs furnish therapy services that are person-centered and that achieve desired clinical outcomes including functional improvement, successful discharges to home and others that are directly impacted by the efforts of professional therapists.”

He said this means SNFs must right-size the amount of therapy to furnish therapy services that are both efficient and effective.  

In addition, Ciolek said to help achieve this desired result, in 2020, AHCA, in collaboration with the University of Colorado, launched a new online and interactive High-Intensity Physical Rehabilitation in Medically Complex Populations training program for physical and occupational therapy professionals that work within the SNF.  

For more information on the TOPS study, click on the Study Summary and 53-page Chartbook.