title: Does payment structure influence change in physical functioning after rehabilitation therapy?
abstract: OBJECTIVE
  To determine if there are differences by payment structure (Medicare managed care versus fee-for-service) in the duration and intensity of geriatric rehabilitation therapy treatments and measure their effect on change in physical functioning at discharge.
  
  
  METHODS
  Sixty-eight Medicare managed care (MCO) and 32 fee-for-service (FFS) subjects from 3 skilled nursing facilities (SNFs) in Southern California answered the physical functioning dimension of the Sickness Impact Profile (SIP-PFD) before and after rehabilitation therapy. Patient characteristics at admission, therapy treatments, and discharge physical functioning were compared by payment structure using chi-square and t-tests; logistic and ordinary least squares (OLS) regressions were employed to determine significant predictors of enrollment in managed care and change in physical functioning at discharge.
  
  
  RESULTS
  Payment structure yielded no significant differences in patient characteristics (physical functioning, socio-demographics, and clinical characteristics) at admission to rehabilitation. Compared to MCO subjects, FFS subjects received significantly more minutes per day (intensity) of rehabilitation therapy (Mean difference = - 16.90; t-test = - 4.504; p =.000). On average, all subjects reported significant, positive change in physical functioning from admission to discharge after rehabilitation (Mean change = 7.98, SD = 12.96; t-test = 6.157; p =.000); but change in physical functioning between MCO and FFS subjects was not significant.
  
  
  CONCLUSIONS
  Payment structure did not significantly influence change in physical functioning at discharge. Future studies, using a larger sample- size, should consider the effects of structural elements, process, and patient behavior on therapy treatments and physical functioning outcomes.
authors.affiliation: Andrus Gerontology Center, University of Southern California, Los Angeles, CA 90028-0191, USA. gshannon@usc.edu
authors.forename: George R
authors.initials: GR
authors.lastname: Shannon
authors.forename: Judy Y
authors.initials: JY
authors.lastname: Yip
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Wilber
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D018588:Fee-for-Service Plans; D006302:Health Services Research; D006801:Humans; D008329:Managed Care Programs; D006278:Medicare; D012046:Rehabilitation; D012051:Reimbursement Mechanisms; D016896:Treatment Outcome; D014481:United States