Prospective payment and the utilization of physical therapy service in the hospitalized elderly.
We studied the effect, in a university teaching hospital, of the prospective payment system (PPS) on utilization of physical therapy (PT), a non-reimbursable service; subjects were hospitalized patients aged 75 or older with non-PT-related diagnoses (myocardial infarction, pneumonia, congestive heart failure, and colectomy) and PT-related diagnoses (cerebrovascular accident and hip fracture). The proportion of patients referred for PT increased from 68 percent pre-PPS to 85 percent post-PPS for those with PT-related diagnoses and from 13 percent pre-PPS to 19 percent post-PPS for those with non-PT-related diagnoses. The mean number of sessions of PT decreased slightly for both groups: from 8.5 to 7.6 sessions for those with PT-related diagnoses and from 5.2 to 4.5 for those with non-PT-related diagnoses. In patients with PT-related diagnoses whose ambulatory status worsened during hospitalization, referrals for PT increased from 76 percent pre-PPS to 98 percent post-PPS. Referrals of comparable patients with non-PT-related diagnoses did not increase. Changes in provider education and efforts to reduce length of stay may account for these findings.
Holt
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St. Luke's Hospital, Kansas City Missouri.
Winograd
C H
CH
D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D010814:Physical Therapy Department, Hospital / Q000706:statistics & numerical data*; D011445:Prospective Payment System; D014481:United States