Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region

Abstract

OBJECTIVE. This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps. METHOD. This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs. RESULTS. Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12–14 visits. DISCUSSION. Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.

A health services research agenda to fully integrate cancer rehabilitation into oncology care

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Immediate Interventions After Surgery to Reduce Readmission for Upper Extremity Infections

“…For simplicity of discussion, this does not account for hospital readmissions or reoperations. Pergolotti et al 20 conducted a study to analyze the average costs of Occupational Therapy and Physical Therapy services in 2012 and 2013 across the United States. For patients in this study, our hand therapy team would bill insurance, the patient or Medicaid as follows: (1) initial patient evaluation, (2) therapeutic activities, (3) therapeutic exercises, and (4) manual therapy services.…”

Family perspectives on gaps in health care for people with Down syndrome

“…Families of children with DS aged 0-16 years found their needs met with therapy services at a DS specialty clinic, while families of children with DS 17 years and older found their needs unmet. Many centers may not have been able to provide occupational, speech, or physical therapy consultation due to insurance caps, variation in costs in insurance plans, or differences in coverage between private and public insurances (Carvalho et al, 2017;Fuentes et al, 2017;Pergolotti et al, 2018;Santoro, Campbell, et al, 2021;Santoro, Donelan, et al, 2021;Zhang & Baranek, 2016). Santoro et al surveyed staff at DS specialty clinics that serve adults.…”