Payer incentives and physical rehabilitation therapy for non-elderly institutional long-term care residents: evidence from Michigan and Ontario.

Abstract

Objective: The purpose of this study is to examine the effect of payment incentives on the provision rehabilitation therapy to non-elderly nursing home residents. Design: Retrospective cross-sectional study. Participants and Setting: All non-elderly nursing home residents admitted to nursing homes in Michigan, U.S.A. or Complex Continuing Care facilities in Ontario, Canada in 1998 or 1999 (n=5,189) Main Outcome: The focus for the present study is the effect of payment on access to physical therapy (PT) and occupational therapy (OT) and total weekly therapy time for each therapy type. Results: A Medicare policy change from cost-based to a patient-specific case-mix payment method was associated with greater likelihood of receiving OT but reduced weekly minutes of PT and OT provided to residents. Medicare cost-based and private-insurance was associated with greater likelihood of receiving OT and PT and more therapy time for both types of therapy compared to private-pay residents. Global budget payment was associated with greater access to PT but less weekly minutes of OT and PT . Conclusions: Little information exists to describe the characteristics and treatment of non-elderly nursing home residents. This study finds that many of these residents receive rehabilitation and that residents whose care is paid for by more generous payers such as Medicare receive more therapy than those paid for by less generous payers.