title: Prospective payment for nursing homes increased therapy provision without improving community discharge rates.
abstract: OBJECTIVE
  To determine the impact of the prospective payment system (PPS) for skilled nursing facilities (SNFs) on therapy use and community discharge rates.
  
  
  METHODS
  Quasi-experimental study examining the predemonstration (1994) to demonstration (1997) change in amount of therapy provided, and in community discharge rates at PPS participating and nonparticipating facilities.
  
  
  METHODS
  Eighteen PPS participating and 17 nonparticipating SNFs in five states.
  
  
  METHODS
  Two thousand sixty-seven admissions to 18 PPS participating and 17 nonparticipating SNFs in five states.
  
  
  METHODS
  We compared changes in number of physical and occupational therapy visits per stay for patients receiving therapy and likelihood of being located in the community 60 days after admission between 1994 and 1997. Analyses were stratified by functional category and risk adjusted using multivariate methods.
  
  
  RESULTS
  Demographics and percentage of patients in each stratum were similar in participating and nonparticipating sites and between 1994 and 1997. Amount of therapy received by the highest-functioning patients increased in participating sites (19.3 to 26.5 visits per stay, P = .005), but not in nonparticipating sites (23.3 to 18.2, P = .98). After adjusting for covariates, likelihood of community discharge for the highest-functioning patients did not change between participating and nonparticipating sites.
  
  
  CONCLUSIONS
  The highest-functioning patients treated under the SNF PPS demonstration experienced great increases in therapy, without any improvement in rate of community discharge.
authors.affiliation: Center on Aging Research Section, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA.
authors.forename: E
authors.initials: E
authors.lastname: Hutt
authors.forename: M
authors.initials: M
authors.lastname: Ecord
authors.forename: T B
authors.initials: TB
authors.lastname: Eilertsen
authors.forename: E
authors.initials: E
authors.lastname: Frederickson
authors.forename: J C
authors.initials: JC
authors.lastname: Kowalsky
authors.forename: A M
authors.initials: AM
authors.lastname: Kramer
mesh_terms: D000368:Aged; D003953:Diagnosis-Related Groups; D006801:Humans; D016013:Likelihood Functions; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000191:economics*; D009788:Occupational Therapy / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011445:Prospective Payment System; D020127:Recovery of Function; D012044:Regression Analysis; D012046:Rehabilitation / Q000191:economics; D020379:Risk Adjustment; D014481:United States