Date Presented 03/27/20
Using 2016 and 2017 Uniform Data System for Medical Rehabilitation (UDSMR) from the United States, we examined utilization of rehabilitation services among adults admitted to inpatient rehabilitation facilities and examine patient and facility characteristics associated with variation in rehabilitation services provided for stroke, fracture of the lower extremity, and major joint replacement of the lower extremity.
Primary Author and Speaker: Ickpyo Hong
Additional Authors and Speakers: Amol Karmarkar, Amit Kumar, Amber Armstead, Lin-Na Chou, Kenneth Ottenbacher
PURPOSE: The Centers for Medicare and Medicaid Services mandate the collection of rehabilitation therapy utilization data to improve the quality of care and accuracy of payments (Centers for Medicare Medicaid Services, 2014). While rehabilitation service use can provide valuable information about the current rehabilitation services in Inpatient Rehabilitation Facilities (IRF) settings (Medicare Payment Advisory Commission, 2018), no studies have reported descriptive information of the use of occupational therapy and physical therapy service utilization. Therefore, the purpose of this study was to provide descriptive information of the utilization of rehabilitation therapy in IRFs and examine the relationships between patient- and facility-level characteristics and use of rehabilitation therapy across three common impairment groups in IRF setting, including patients with stroke, lower extremity fracture, and major joint replacement of the lower extremity.
DESIGN: A secondary data analysis using a retrospective cohort design.
METHOD: We retrieved patients with stroke (n=91,243), lower extremity fracture (n=53,728), lower extremity joint replacement (n=22,235) from inpatient rehabilitation in the Uniform Data System for Medical Rehabilitation (UDSMR) from October 1st, 2016 and December 31st, 2017. This database contains inpatient rehabilitation units and facilities’ information. Hospital-based rehabilitation service was the primary dependent variable of interest, including total number of minutes provided by individual physical therapy and occupational therapy during the first 2 weeks defined by Centers for Medicare and Medicaid Services. For the descriptive analysis, we utilized demographic, clinical and facility factor variables and rehabilitation outcomes included in the Inpatient Rehabilitation Facilities – Patient Assessment Instrument (IRF-PAI) and the UDSMR. Generalized linear models with multinomial distribution were used to examine the relationships between rehabilitation therapy utilization (minutes) and individual- and facility-level characteristics across therapy per weeks and the three chronic condition groups. Lastly, we examined the variation in amount of rehabilitation therapy minutes by facilities characteristics using hierarchical linear models with 2-level fixed effect and random intercept.
RESULTS: During the first 2 weeks, patients with stroke received more rehabilitation therapy minutes (1120.89, SD=390.56) than those with fracture of the lower extremity (1199.42, SD=368.14), and major joint replacement of lower extremity (964.31, SD=367.64). Generalized linear models demonstrated that patients being admitted to small facility, older age, being discharged to community, a longer length of stay, and a higher cognition score received more rehabilitation therapy minutes (p<0.05). In addition, the hierarchical linear models revealed that there were significant variations in rehabilitation therapy minutes across the payment type (Medicare Fee-For-Service, Medicare Advantage, and Commercial) in the all three chronic conditions.
CONCLUSION: We identified considerable variation in the use of rehabilitation therapy by facility and types of insurance. Patient- and facility-level characteristics were associated with the amount of rehabilitation therapy minutes provided. In addition, rehabilitation therapy minutes were varied across the payment type and the three chronic conditions.
IMPACT STATEMENT: The study findings of the patterns of rehabilitation service use across the common chronic condition groups will help policymakers improve rehabilitation services and quality of care of the current Inpatient Rehabilitation Facility Prospective Payment System.
References
Centers for Medicare Medicaid Services. (2014). Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015. 79(151), 45871.
Medicare Payment Advisory Commission. (2018). Healthcare spending and the Medicare program. Retrieved from Washington, DC: MedPAC.
