Multiparticipant Rehabilitation in Skilled Nursing Facilities: An Observational Comparison Study

Skilled Nursing Facility Organizational Characteristics Are More Strongly Associated With Multiparticipant Therapy Provision Than Patient Characteristics

“…5 , 9 Patient characteristics associated with receiving any multiparticipant therapy in our models are consistent with a previous study of patients in a single SNF by Gustavson et al, which also found slightly higher odds of multiparticipant therapy in patients with better function and cognitive status who had longer LOS and received more therapy overall. 18 Together, these results suggest that individuals with higher levels of functional deficits or diagnoses with significant functional impairment such as paraplegia and multiple sclerosis may require more individualized therapy and support for safety with mobility during treatment sessions, making them less appropriate for multiparticipant therapy provision. 31 Additionally, it may be more challenging for therapists to engage individuals with cognitive impairments and behavioral symptoms such as psychosis or rejection of care in multiparticipant therapy sessions.…”

“…Previous research by Gustavson et al found no relationship between the proportion of multiparticipant therapy and specific functional outcome measures of gait speed and the short physical performance battery; however, this was a small sample size in a single SNF. 18 Although the tendency for low-quality SNFs to provide higher rates of multiparticipant therapy supports the CMS cutoff for 25% multiparticipant therapy under PDPM, the broad nature of quality measures used in the 5-star rating system does not allow for specific conclusions about relationships between multiparticipant therapy and rehabilitation-sensitive outcomes. Thus, more research is needed to determine the impact of multiparticipant therapy on specific patient quality outcomes.…”

“…Finally, targeted monitoring for increases in multiparticipant therapy under PDPM is important, because the increase in multiparticipant therapy provision in response to new financial incentives under PDPM is not clinically indicated by a concurrent sudden shift in patient case mix or practice recommendations. 15 We are aware of only 1 small study examining multiparticipant therapy and patient outcomes, which showed no association between multiparticipant therapy and patient function 18 ; thus, the impact of financially motivated precipitous increases in multiparticipant therapy on patient outcomes is unknown.…”

Some But Not Too Much: Multiparticipant Therapy and Positive Patient Outcomes in Skilled Nursing Facilities

“…10 Multiparticipant therapy allows SNFs to provide therapy sessions to the same number of patients with fewer therapy staff and has thus been considered as a way to reduce labor costs. 11,12 Multiparticipant therapy was not incentivized under the PPS and made up less than 1% of total therapy minutes prior to the PDPM. 12 The literature has not fully described how clinical decisions are made in terms of including certain patients in individual versus multiparticipant therapy sessions.…”

“…[18][19][20][21][22] Only 1 study has examined relationships between multiparticipant therapy and rehabilitation outcomes in SNFs, finding no significant association between multiparticipant therapy provision and patient improvement in gait speed or balance. 11 However, this small study included patients from only 1 facility and used clinical outcome measures that the CMS does not monitor as part of its quality initiatives. Another study found that low-quality SNFs were more likely to provide 25% or more multiparticipant therapy prior to the PDPM; however, the 5-star quality measure used in this study provides a broad facility-level summary of overall nursing and rehabilitation quality in SNFs and may not accurately reflect relationships between multiparticipant therapy and patient-specific Research Report outcomes.…”