Publication date: Available online 1 September 2018
Source: Archives of Physical Medicine and Rehabilitation
Author(s): Justine Dee, Benjamin Littenberg
Abstract
Objective
To determine if there was a change in the number of outpatient physical therapy (PT) and occupational therapy (OT) visits for Medicare beneficiaries, and in the number of beneficiaries receiving extended courses of >12 therapy visits, after the "Jimmo v. Sebelius" settlement.
Design
Cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) comparing calendar years 2011 through 2012 to 2014 through 2015.
Setting
Community in-home survey.
Participants
Medicare Part-B recipients who received outpatient PT/OT (N=1183, median age 70.8) during pre (2011-2012) and post-Jimmo settlement (2014-2015) time periods.
Intervention
Not applicable
Main Outcome Measures
Number of therapy visits/patient/year and number of subjects who received > 12 therapy visits/year estimated by linear and logistic regressions controlling for potential confounders (age, body mass index, and geographic region).
Results
The unadjusted median number of therapy visits/year increased from 7 to 8 after the settlement. Linear regression estimated a 1.02 increase in the number of therapy visits after the settlement (95% confidence interval (CI) 0.23,1.80; P=0.01). The odds of having >12 therapy visits/year increased (odds ratio = 1.41; 95% CI 1.02,1.96; P= .04). We observed a significant interaction between race and the effect of the settlement on the odds of having >12 therapy visits (OR 3.64; 95% CI 1.58, 8.39). White subjects saw an increase in utilization while non-white subjects' utilization declined.
Conclusion
Utilization of outpatient PT/OT changed after the 2013 Jimmo settlement. Further research is needed to determine the impact on patient outcomes and cost.
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