RTI International, 230 West Monroe Street, Suite 2100, Chicago, IL 60606 (USA).
RTI International, Waltham, Massachusetts.
Phys Ther. 2019 May 1;99(5):526-539. doi: 10.1093/ptj/pzz023.
Clinical characteristics driving variations in Medicare outpatient physical therapy expenditures are inadequately understood.
The objectives of this study were to examine variations in annual outpatient physical therapy expenditures of Medicare fee-for-service beneficiaries by primary diagnosis and baseline functional mobility, and to assess whether case mix groups based on primary diagnosis and functional mobility scores would be useful for expenditure differentiation.
This was an observational, longitudinal study.
Volunteer providers in community settings participated in data collection with Continuity Assessment Record and Evaluation-Community (CARE-C) assessments for Medicare fee-for-service beneficiaries. Annual outpatient physical therapy expenditures were calculated using allowed charges on Medicare claims; primary diagnosis and baseline functional mobility were obtained from CARE-C assessments. Whether annual expenditures varied significantly across primary diagnosis groups and within diagnosis groups by functional mobility was examined.
Data for 4210 patients (mean [SD] age = 72.9 [9.9] years; 64.6% women) from 127 providers were included. Mean expenditures differed significantly across 12 primary diagnosis groups created from CARE-C clinician-reported diagnoses (F = 12.73; df = 11). Twenty-five pairwise differences in 66 pairwise diagnosis group comparisons were statistically significant. Within 8 diagnosis groups, expenditures were significantly higher for low-mobility subgroups than for high-mobility subgroups; borderline significance was achieved for 1 diagnosis group.
The small convenience sample limited the statistical power and the generalizability of the results.
Significant variations in physical therapy expenditures based on primary diagnosis and baseline functional mobility support the use of these variables in predicting outpatient physical therapy expenditures. Although Medicare's annual therapy spending cap was repealed effective January 2018, the data from this study provide an initial foundation to inform any future policy efforts, such as targeted medical review, risk-adjusted therapy payments, or case mix groups as potential payment alternatives. Additional research with larger samples is needed to further develop and test case mix groups and improve generalizability to the national population. Refined case mix groups could also help providers prognosticate physical therapy expenditures based on patient profiles.
导致医疗保险门诊物理治疗支出差异的临床特征尚未得到充分理解。
本研究旨在检查医疗保险按服务收费受益人的年度门诊物理治疗支出因主要诊断和基线功能移动性的变化，并评估是否基于主要诊断和功能移动性评分的病例组合组可用于支出区分。
这是一项观察性、纵向研究。
社区环境中的志愿提供者参与了医疗保险按服务收费受益人的连续性评估记录和社区评估（CARE-C）评估的数据收集。使用医疗保险索赔中的允许收费计算年度门诊物理治疗支出；从 CARE-C 评估中获得主要诊断和基线功能移动性。检查主要诊断组之间和诊断组内功能移动性的年度支出是否有显著差异。
共纳入来自 127 名提供者的 4210 名患者（平均[标准差]年龄=72.9[9.9]岁；64.6%为女性）的数据。12 个从 CARE-C 临床医生报告的诊断中创建的主要诊断组之间的平均支出差异显著（F=12.73；df=11）。在 66 个诊断组比较的 25 个成对比较中，有统计学意义。在 8 个诊断组中，低流动性亚组的支出明显高于高流动性亚组；在 1 个诊断组中，达到了边缘显著水平。
小样本的便利性限制了统计效力和结果的普遍性。
基于主要诊断和基线功能移动性的物理治疗支出的显著差异支持使用这些变量预测门诊物理治疗支出。尽管 2018 年 1 月医疗保险的年度治疗支出上限已被废除，但本研究的数据为任何未来的政策努力提供了初步基础，例如有针对性的医疗审查、风险调整后的治疗支付或病例组合组作为潜在的支付替代方案。需要进行具有更大样本量的进一步研究，以进一步开发和测试病例组合组，并提高对全国人口的普遍性。改进的病例组合组还可以帮助提供者根据患者资料预测物理治疗支出。
