Post-Acute Care Admissions Among Medicare Beneficiaries with Disabilities During Payment Reform and the COVID-19 Pandemic.

Background And Objectives: Recent Medicare payment reforms aimed to improve post-acute access to skilled nursing facilities (SNFs) and home health agencies (HHAs) for patients with complex care needs, including beneficiaries with disabilities. Soon after reforms were implemented, the COVID-19 pandemic began, which disproportionately impacted older adults and people with disabilities. Leveraging Medicare administrative data to identify two distinct cohorts of beneficiaries with disabilities, this study explored changes in their SNF and HHA admission patterns during payment reform and COVID-19.

Changes in skilled nursing and home health admissions associated with Medicare payment reforms and the COVID-19 pandemic.

Background: Shortly after Medicare implemented post-acute care payment reforms, the COVID-19 pandemic began, but little is known about how these reforms and the pandemic impacted admissions to the most common post-acute settings-skilled nursing facilities (SNF) and home health agencies (HHAs)-for the full Medicare fee-for-service population.

Methods: Using 100% of Medicare fee-for-service data, we conducted adjusted interrupted time series analyses of 31,730,994 hospital stays of all adult beneficiaries discharged alive from the hospital between 2018 and 2021 to examine whether payment reforms and the pandemic were associated with differences in admissions to SNFs and HHAs compared to pre-reform and pre-COVID (baseline) trends.

Results: At baseline, an average 18.

Skilled Nursing and Home Health Policy: A Primer for the Hospital Clinician.

This paper addresses the increasing challenges faced by hospital clinicians in coordinating and recommending postacute care for patients, focusing on issues related to access to the most common postacute services: skilled nursing facilities (SNFs) and home health agencies (HHAs). In coordinating discharges, hospital clinicians have minimal information on care delivery in these settings. This knowledge gap is exacerbated by the disrupted continuum of patient care between acute care hospitals, SNFs, and HHAs.

Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review.

Objective: This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment.

Methods: Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley methodological framework was adapted for this scoping review.

Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.

Objective: To examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed throughout the pandemic in order to provide recommendations for policies and practices used to strengthen the SNF workforce moving forward.

Study Setting And Design: For this qualitative study, we engaged a purposive national sample of SNF leaders (n = 94) in one-on-one interviews between January 2021 and December 2022.

Utilization and Potential Disparities in Access to Physical Therapy for Spine Pain in the Long-Term Care Population.

Objective: To determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings.

Design: Secondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date.

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage.

Importance: Private Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.

Patient Characteristics and Treatment Patterns for Speech-Language Pathology Services in Skilled Nursing Facilities.

Purpose: Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services.

Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol.

In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19.

Skilled Nursing Facility Changes in Ownership and Short-Stay Medicare Patient Outcomes.

Importance: Skilled nursing facility (SNF) changes in ownership are receiving attention in the national conversation regarding health care quality and oversight. SNF ownership changes have been cited as possible ways for SNFs to obscure financial arrangements and shift funds away from patient care; however, it is unclear whether ownership changes are associated with quality outcomes, especially for short-stay patients.

Objective: To determine which SNF characteristics are associated with changes in ownership and whether ownership changes were associated with differences in short-stay patient outcomes.

Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities.

Background: Implementation of new skilled nursing facility (SNF) Medicare payment policy, the Patient Driven Payment Model (PDPM), resulted in immediate declines in physical and occupational therapy staffing. This study characterizes continuing impacts of PDPM in conjunction with COVID-19 on SNF therapy staffing and examines variability in staffing changes based on SNF organizational characteristics.

Methods: We analyzed Medicare administrative data from a national cohort of SNFs between January 2019 and March 2022.

Some But Not Too Much: Multiparticipant Therapy and Positive Patient Outcomes in Skilled Nursing Facilities.

Background And Purpose: Physical and occupational therapy practices in skilled nursing facilities (SNFs) were greatly impacted by the 2019 Medicare Patient-Driven Payment Model (PDPM). Under the PDPM, the practice of multiparticipant therapy-treating more than one patient per therapy provider per session-increased in SNFs, but it is unknown how substituting multiparticipant therapy for individualized therapy may impact patient outcomes. This cross-sectional study establishes baseline relationships between multiparticipant therapy and patient outcomes using pre-PDPM data.

Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics.

Objectives: Multiparticipant physical and occupational therapy provision has fluctuated significantly in skilled nursing facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2-6 individuals per therapist) and concurrent therapy (2 individuals per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic.

Medicare payment policy in skilled nursing facilities: Lessons from a history of mixed success.

The current policy environment for rehabilitation in skilled nursing facilities (SNFs) is complex and dynamic, and SNFs are facing the dual challenges of recent Medicare payment policy change that disproportionately impacts rehabilitation for older adults and the COVID-19 pandemic. This article introduces an adapted framework based on Donabedian's model for evaluating quality of care and applies it to decades of Medicare payment policy to provide a historical view of how payment policy changes have impacted rehabilitation processes and patient outcomes for Medicare beneficiaries in SNFs. This review demonstrates how SNF responses to Medicare payment policy have historically varied based on organizational factors, highlighting the importance of considering such organizational factors in monitoring policy response and patient outcomes.

Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities.

Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics.

The association between sleep deficits and sedentary behavior in people with mild Parkinson disease.

Sleep deficits are a common nonmotor symptom of Parkinson disease (PD). People with mild PD also achieve less physical activity (PA) than healthy older adults (HOA), but the relationship between sleep and PA in PD is unclear. This study examined associations between sleep and PA in participants with PD and HOA.

Therapy Staffing in Skilled Nursing Facilities Declined after Implementation of the Patient-Driven Payment Model.

Objective: The Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review.

Objective: Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet, there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs.

Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors.

Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants.

Skilled Nursing Facility Characteristics Associated With Financially Motivated Therapy and Relation to Quality.

Objectives: In October 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment model for skilled nursing facilities (SNFs) that eliminated financial incentives to provide high-intensity therapy. Yet high-intensity therapy in SNFs has been linked to better quality outcomes, potentially putting patients at risk if clinically indicated therapy is reduced under the new payment model. A metric to help differentiate between financially motivated vs clinically indicated therapy in SNFs is thresholding: the percentage of patients receiving therapy within 10 minutes of reimbursement thresholds.