Date Presented 03/22/24
Outpatient treatments may differ for rural, nonrural, and socially disadvantaged Medicare stroke survivors. The results of this study may help influence telerehabilitation reimbursement policy to improve equitable access to care.
Primary Author and Speaker: Corey Morrow
Contributing Authors: Michelle L. Woodbury, Kit Simpson
PURPOSE: Despite evidence that rehabilitation improves stroke survivors’ function and quality of life, access to outpatient occupational therapy is limited. Additionally, real-world treatment approaches are not well known. The objective of this study was to analyze treatment billing practices to answer the following: What types of treatments do stroke survivors receive? And does it differ in rural, nonrural, and socially disadvantaged communities?
DESIGN: The study design was a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services for adult ischemic stroke survivors.
METHOD: Stroke survivors who received outpatient rehabilitation were identified. Then, rehabilitation Current Procedural Terminology (CPT) treatment codes were used to examine differences in outpatient therapy treatment approaches. Stroke survivors were stratified into stroke severity, rural, non-rural, and socially disadvantaged (SDA) subpopulations. Results are reported in frequency counts and proportions with chi-squares to determine statistically significant group differences.
RESULTS: For the 9,076 stroke survivors in this cohort, the most frequently used CPT codes were Therapeutic Exercise (31.3%), Therapeutic Activity (20.4%), and Neuromuscular Re-Education (19.6%). Interestingly, rural patients with severe strokes experienced less Neuromuscular Re-Education (22.5% for nonrural versus 13.5% rural) and more Therapeutic Exercise (28.5% non-rural versus 42.8% rural). For socially disadvantaged stroke survivors, Self-Care treatments were alarmingly rare (0.2%).
CONCLUSIONS: This study is impactful because it describes treatment approach discrepancies for stroke survivors based on their county residence. The results may drive further conversation about policy changes such as increased telerehabilitation reimbursement to create equitable access to stroke rehabilitation treatment.
References
Freburger, J. K., Li, D., & Fraher, E. P. (2018). Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital Readmission. Archives of Physical Medicine and Rehabilitation, 99(1), 26–34.e25. https://doi.org/10.1016/j.apmr.2017.07.011
Freburger, J. K., Li, D., Johnson, A. M., & Fraher, E. P. (2018). Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care. Archives of Physical Medicine and Rehabilitation, 99(6), 1077–1089.e1077.
Jia, H., Cowper, D. C., Tang, Y., Litt, E., & Wilson, L. (2012). Postacute stroke rehabilitation utilization: are there differences between rural-urban patients and taxonomies? Journal of Rural Health, 28(3), 242–247. https://doi.org/10.1111/j.1748-0361.2011.00397.x
MacDowell, M., Glasser, M., Fitts, M., Nielsen, K., & Hunsaker, M. (2010). A national view of rural health workforce issues in the USA. Rural and Remote Health, 10(3), 1531–1531. https://pubmed.ncbi.nlm.nih.gov/20658893
