Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Abstract

Objective-To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design-Data from the nationally representative Medicare Current Beneficiary Survey (MCBS)were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings-Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants-Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions-Not applicable.Main Outcome Measures-Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results-Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR] Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This article uses a nationally representative database to analyze the use of 2 PAC servicesphysical (PT) and occupational therapy (OT)-by Medicare beneficiaries with five common diagnoses across various settings of care before and after the 1997 BBA. Looking simultaneously at service use across different rehabilitation settings is important because changes in 1 sector could alter care patterns in another setting. Additionally, exploring changes in service use is complicated by differing timeframes for implementing BBAmandated prospective payment across PAC settings (fig 1). For instance, the BBA created an interim payment system for home health agencies, which was phased in over 12 months beginning October 1, 1997, and controlled both average spending per visit and per Medicare beneficiary; full home health agency prospective payment was implemented in October 2000. A prospective payment system (PPS) was implemented for SNFs in July 1998, and in January 2002 for IRFs. For outpatient therapy, the BBA imposed 2 annual $1500 caps-one for PT...

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