Healthcare professional helps senior woman walk with a walker

Older residents, with or without dementia, who underwent physical rehabilitation at skilled nursing facilities (SNFs) following hospital discharge did not experience significant improvement in their physical function, according to new research.

Published online in the Annals of Long-Term Care on Sept. 12, the study sought to examine the effects of physical therapy and occupational therapy on changes in physical function, from admission to quarterly assessment or discharge, in older patients with and without dementia.

Researchers from the Boston College Cornell School of Nursing, Penn State College of Nursing and University of New Mexico analyzed assessment data of 23,677 patients, age 65 and older, who were admitted to skilled nursing facilities from acute care hospitals in Massachusetts in 2013.

Therapy provider representatives noted that the research has been countered by other studies and is based on 10-year-old findings. In addition, federal payment and regulatory models have evolved over the last decade.

“This study has curious findings and I would point out that there are many other studies that show the therapeutic value of rehab therapy,” noted ADVION Executive Vice President Cynthia Morton in response to the study’s release. “I also believe its relevant that this study covers data from 2013 and Medicare’s assessment methods are different and improved than 10 years ago, in addition to the significant change in reimbursement systems in moving from RUGS to Patient Driven Payment Model (PDPM).”  

After controlling for demographic factors such as age, sex and race, and other factors such as dementia, vision, hearing and delirium, the researchers said they did not find any significant effect in charges in physical function for patients who had undergone physical rehabilitation at a skilled nursing facility 60 days after admission. The findings were true for both dementia and non-dementia patients.  

“The results indicate that for SNF patients with and without dementia, PT and OT did not lead to a significant improvement in physical function,” the researchers wrote.

They said their findings do not suggest that rehabilitation plans are ineffective, but do suggest the need for further study about the effectiveness of current treatment approaches, and the need to tailor rehabilitation plans to patients’ individual characteristics and needs.

“Findings suggest the advisability of aligning reimbursement with rehabilitative approaches that are individualized to patient needs and unique situations, while also considering preferences, to optimize performance outcomes,” the authors concluded. “Furthermore, controlling cost containment measures must consider support in the home or community as well as a host of personal factors that may impact a person’s ability to receive family or community support to return home.”

The Centers for Medicare & Medicaid Services has moved on from Section G of the Minimum Data Set. Through the authority of the IMPACT Act, CMS has been requiring providers to collect data for the new Section GG for several years, therapy industry professionals pointed out. The new MDS with GG in play will go live Oct. 1.

“Through working with ADVION, we have looked at Section GG data for millions of patients in nursing homes across the country and the data shows that therapy has improved function for these patients,” said Symbria President and CEO Jill Krueger.

Editor’s note: This article has been updated to include additional perspective from the therapy sector, and make mention of the new evaluation and payment processes that go into effect Oct.1.