Did Clarification of Medicare Guidelines Change Outpatient Physical Therapy and Occupational Therapy Usage? A Retrospective Analysis.

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 vs Sebelius settlement.

Design: Cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) comparing calendar years 2011-2012 to 2014-2015.

Setting: Community in-home survey.

Participants: Medicare Part-B recipients who received outpatient PT/OT (N=1183, median age 70.8) during pre-Jimmo settlement (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 [BMI], 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=.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). Non-Hispanic white subjects saw an increase in utilization while a combined group of black, Hispanic and Asian subjects' utilization declined.

Conclusion: Utilization of outpatient PT/OT changed after the 2013 Jimmo settlement. Further research is needed to determine the effect on patient outcomes and cost.