Prusynski Rachel A, Amaravadi Harsha, Brown Cait, Leland Natalie E, Saliba Debra, Frogner Bianca K, Freburger Janet, Mroz Tracy M
University of Washington Department of Rehabilitation Medicine, Seattle, WA; University of Washington Center for Health Workforce Studies, Seattle, WA; University of Washington Department of Health Systems and Population Health, Seattle, WA.
University of Washington Department of Health Systems and Population Health, Seattle, WA.
Arch Phys Med Rehabil. 2025 Jun 6. doi: 10.1016/j.apmr.2025.05.020.
To examine how rehabilitation service provisions (ie, physical therapy [PT], occupational therapy [OT], speech language pathology [SLP]) changed in skilled nursing facilities (SNFs) after Medicare implemented the Patient-Driven Payment Model (PDPM) and the COVID-19 pandemic began, while comprehensively accounting for changes in patient clinical characteristics.
Secondary interrupted time series analysis of 100% Medicare data from January 2018 to September 2021 with interruptions for PDPM implementation (October 2019) and COVID-19 (March 2020).
United States SNFs.
All SNF stays for fee-for-service Medicare beneficiaries admitted to SNF within 3 days of hospitalization with complete data from SNF assessments and hospital claims. Stratified analyses included stays with facility data on ownership status and rural versus urban location.
Not applicable.
Average total minutes of therapy per day (MTD) provided by assistants or therapists and MTD by discipline (ie, PT, OT, SLP).
For 3,917,261 SNF stays, PDPM implementation was associated with a decline of 28.9 total MTD, representing a relative reduction of 23.7%, compared to pre-PDPM averages. PT declined by 12.8 MTD (-23.5%), OT by 12.9 MTD (-24.3%), and SLP by 3.1 MTD (-21.7%). PDPM-associated declines were larger in for-profit SNFs versus not-for-profit and government-owned SNFs and in rural versus urban SNFs. Compared to what would have occurred if post-PDPM negative trends continued, COVID-19 was associated with a 15.3 minute (15.9%) increase in total MTD, a 5.4 minute (12.8%) increase for PT, a 5.1 minute (12.3%) rebound for OT, and a 4.5 minute (38.9%) increase for SLP, with greater relative increases in urban and for-profit SNFs.
Even when accounting for changing patient characteristics over time, PDPM implementation was associated with substantial declines in therapy provision, particularly in for-profit and rural SNFs. After COVID-19, these steep declines stabilized, with a slight recovery for SLP, but lower levels of PT and OT MTD persisted well into the pandemic.
研究在医疗保险实施患者驱动支付模式（PDPM）以及新冠疫情开始后，熟练护理机构（SNFs）的康复服务提供情况（即物理治疗[PT]、职业治疗[OT]、言语语言病理学[SLP]）如何变化，同时全面考虑患者临床特征的变化。
对2018年1月至2021年9月100%的医疗保险数据进行二次中断时间序列分析，PDPM实施（2019年10月）和新冠疫情（2020年3月）为中断点。
美国的熟练护理机构。
所有在住院3天内入住SNF的按服务收费医疗保险受益人的SNF住院记录，且有来自SNF评估和医院理赔的完整数据。分层分析包括有机构所有权状态以及农村与城市位置相关设施数据的住院记录。
不适用。
助理或治疗师每天提供的平均总治疗分钟数（MTD）以及各学科的MTD（即PT、OT、SLP）。
对于3917261次SNF住院记录，与实施PDPM前的平均水平相比，PDPM的实施使总MTD下降了28.9分钟，相对减少了23.7%。PT下降了12.8分钟（-23.5%），OT下降了12.9分钟（-24.3%），SLP下降了3.1分钟（-21.7%）。与非营利性和政府所有的SNF相比，营利性SNF中与PDPM相关的下降幅度更大；与城市SNF相比，农村SNF中与PDPM相关的下降幅度更大。与如果PDPM实施后的负面趋势持续下去的情况相比，新冠疫情使总MTD增加了15.3分钟（15.9%），PT增加了5.4分钟（12.8%），OT反弹了5.1分钟（12.3%），SLP增加了4.5分钟（38.9%），城市和营利性SNF中的相对增加幅度更大。
即使考虑到患者特征随时间的变化，PDPM的实施仍与治疗服务提供的大幅下降相关，特别是在营利性和农村SNF中。新冠疫情后，这些急剧下降的趋势趋于稳定，SLP略有恢复，但PT和OT的MTD水平在疫情期间一直保持在较低水平。
