Original research| Volume 99, ISSUE 1, P107-115, January 2018

Association Between Therapy Intensity and Discharge Outcomes in Aged Medicare Skilled Nursing Facilities Admissions

Published:August 28, 2017DOI:


      • Sixty minutes per week of combined therapy was associated with community discharge.
      • Less than 60 minutes of therapy was associated with hospital discharge, placement, and death.
      • A minimum of 60 minutes of therapy was associated with 2 fewer days in a skilled nursing facility.



      To determine the association between therapy intensity and discharge outcomes for aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and to determine the association between therapy intensity and time to community discharge.


      Retrospective observational design.




      Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs.


      The total minutes of physical therapy, occupational therapy, and speech therapy per day were divided into intensity groups: high (≥60min); medium-high (45–<60min); medium-low (30–<45min); and low (<30min).

      Main Outcome Measures

      Four discharge outcomes—community, hospitalization, permanent placement, and death—were examined using a multivariate competing hazards model. For those associated with community discharge, a Poisson multivariate model was used to determine whether length of stay differed by intensity.


      High intensity therapy was associated with more community discharges in comparison to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high, medium-low, and low intensity groups, respectively). More hospitalizations and deaths were found as therapy intensity decreased. Only high intensity therapy was associated with a 2-day shorter length of stay (incident rate ratio, .95).


      High intensity therapy was associated with desirable discharge outcomes and may shorten SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services, there may be desirable benefits to beneficiaries who receive high intensity therapy.


      List of abbreviations:

      CI (confidence interval), HR (hazard ratio), LOS (length of stay), MDS (Minimum Data Set), OT (occupational therapy), PPS (prospective payment system), PT (physical therapy), SNF (skilled nursing facility), ST (speech therapy)
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