Abstract
Objective
To conduct an analysis of Medicare outpatient therapy episodes of care and associated
payment implications.
Design
Retrospective observational design using Medicare claims data. To descriptively analyze
the composition of outpatient therapy episodes, both variable- and fixed-length episodes
are explored. The variable-length episode definition organizes services into episodes
based on the time pattern of therapy service utilization, using 60-day clean periods.
Fixed-length episodes are also examined, beginning with the first therapy utilization
in calendar year 2010 and extending 30, 60, and 90 days.
Setting
The study is focused on community-dwelling users of outpatient therapy.
Participants
The sample includes all Medicare patients who used outpatient therapy beginning at
any point in 2010.
Interventions
Not applicable.
Main Outcome Measures
Mean episode payments and episode lengths in calendar days.
Results
Variable-length outpatient therapy episodes have a mean payment of $881. On average,
outpatient therapy episodes last 43 calendar days. Mean therapy durations for the
30-, 60-, and 90-day fixed-length episodes are 20, 31, and 38 calendar days, respectively.
The 30-, 60-, and 90-day fixed-length initial episodes account for 40%, 55%, and 63%,
respectively, of total Medicare payments. Simulations of episode-based payment illustrate
the difficulty of avoiding a large number of substantial underpayments, because of
the right-skewed distribution of total actual payments.
Conclusions
A strength of episode payment is that it reduces cost and potentially wasteful variation
within episodes. Given the substantial variation in therapy episode expenditures,
absent improvements in available data and in predictive information, a pure lump sum
episode payment would result in substantial revenue changes for many episodes. Additional
data are needed to better explain the wide variation in episode expenditures.
Keywords
List of abbreviations:
CY (calendar year), FFS (fee for service), OT (occupational therapy), PT (physical therapy), SLP (speech-language pathology)To read this article in full you will need to make a payment
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References
- Risk assumption in the Medicare bundled payment initiative.Singletrack Analytics, Woodbury2012
- Mandatory Medicare bundled payment—is it ready for prime time?.N Engl J Med. 2015; 373: 1291-1293
- Evaluation of the Medicare acute care episode demonstration.Centers for Medicare and Medicaid Services, IMPAQ International, Washington (DC)2013
- Bundled Payments for Care Improvement Initiative (BPCI) fact sheet.2015 (Available at:) (Accessed November 2, 2015)
- Medicare program. Comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services.Fed Regist. 2015; 80: 41198-41316
- Home health PPS: new payment system, new hope.Caring. 2000; 19: 6-11
- Medicare program. CY 2015 home health prospective payment system rate update. Proposed rule.Fed Regist. 2014; 79: 38386
- Medicare program. Revisions to payment policies under the physician fee schedule and other revisions to Part B for CY2016.Fed Regist. 2015; 80: 41685-41966
- Episode-based payments: charting a course for health care payment reform.National Institute for Health Care Reform, Washington (DC)2010
- Summary: episode-based payment.Mathematica Policy Research, Washington (DC)2009
- Medicare post-acute care episodes and payment bundling.Medicare Medicaid Res Rev. 2014; 4: E1-E12
- Outpatient rehabilitation services payment system evaluation, final project report.AdvanceMed, Baltimore2004
- CY 2008 outpatient therapy utilization report.Computer Sciences Corp, Baltimore2010
- Refinements of the Medicare outpatient therapy annual expenditure limit policy.Phys Ther. 2015; 95: 1638-1649
- Developing outpatient therapy payment alternatives: payment alternatives report.Center for Medicare & Medicaid Innovation, Baltimore2014
- 2010 global report: UNAIDS global report on the AIDS epidemic.UNAIDS, Geneva2010
- Report to the Congress: Medicare payment policy.MedPAC, Washington (DC)2010
- Development of a model episode-based payment system for outpatient therapy services.Centers for Medicare & Medicaid Services, Baltimore2004
Article info
Publication history
Published online: April 05, 2016
Footnotes
Supported by the Centers for Medicare & Medicaid Services (CMS). Any interpretations, opinions, or errors are the responsibility of the authors and not those of CMS.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
