In fact, Medicare patients diagnosed with an ischemic stroke—the most common type of stroke, which occurs when a brain artery becomes blocked, reducing blood flow—who received 75 minutes or more of PT while in the hospital were 14 percent less likely to be readmitted than those who received none. Even 30 minutes lowered the risk of readmission by 10 percent.
Yet the researchers found that the amount of OT, which focuses on helping patients to regain facility with everyday tasks such as getting dressed or using the restroom, had minimal impact on readmission risks.
Kumar believes that PT reduces the risk of hospital readmission in two ways: It helps patients restore movement and regain the ability to accomplish tasks, and it allows physical and occupational therapists to play a role in planning for and preparing patients for the next stage of post-acute care—whether that’s an inpatient rehabilitation facility, a skilled nursing facility, or the patient’s home, with home health care assistance.
In the second paper, the research team found that 61.5 percent of stroke patients received both PT and OT services, 22 percent received only PT, 1.7 percent received only OT and 15 percent received neither PT nor OT. Patients who received physical or occupational therapy on average received 14 more minutes of therapy for each additional day spent in the hospital.
The findings indicate a failure to provide rehabilitation care to patients with more complex needs and with more severe conditions, authors said.
Patients who were dually enrolled in Medicare and Medicaid, indicative of more complex clinical needs and lower socioeconomic status, were 16 percent less likely to receive either rehabilitation service. Patients who had a feeding tube inserted, indicative of a severe stroke, were 53 percent less likely to receive rehabilitation services, the researchers found. The findings indicate a failure to provide rehabilitation care to patients with more complex needs and with more severe conditions, authors said.
On the other hand, patients treated in a hospital with an inpatient rehabilitation unit were more likely to receive rehabilitation services and received 8 more minutes of therapy, on average. This indicates that financial incentives established by the Centers for Medicare and Medicaid Services, such as bundled payment programs, appear to be effective at improving the coordination of acute and post-acute care and improving patient outcomes, Kumar said. In the first study, his team found that patients treated in a hospital with an inpatient rehabilitation unit were 8 percent less likely to be readmitted.
Now Kumar is looking at 2017 Medicare claims data for a variety of potentially disabling conditions including stroke, heart failure, joint replacement, and hip fracture to see if Medicare policy changes since 2010 have improved the amount of rehabilitation services patients receive. Kumar will also examine when rehabilitation services are initiated to see if that has an impact on patient outcomes.
Currently there are no clear guidelines for the timing and amount of rehabilitation services offered during hospital stays, Kumar said. And the current Medicare diagnostic based reimbursement model for hospitals doesn’t include metrics for patient functional status or rehabilitation services, which may disincentivize providers from recommending rehabilitation services, he added.
Kumar thinks a randomized controlled trial on the amount and timing of hospital rehabilitation services is necessary. The results of such a clinical trial could inform clear rehabilitation guidelines from the American Heart Association/American Stroke Association, a revised Medicare payment model, and ultimately better patient outcomes.
Kumar’s co-authors were Deepak Adhikari, Pedro Gozalo, Vincent Mor and Linda Resnik from Brown University as well as Amol Karmarkar from the University of Texas Medical Branch and Janet Freburger from the University of Pittsburgh. The National Institutes of Health and the Foundation for Physical Therapy supported this research