Study Highlights Physical Therapy’s Clinical, Financial Benefits Among Medicare Beneficiaries

Home Health Care News | By Patrick Filbin
Increased physical therapy (PT) utilization is associated with significant reductions in hospitalizations and emergency room visits, more evidence shows.
Meanwhile, home health providers are still grappling with how to manage physical therapy under the Patient-Driven Groupings Model (PDGM).
A new study from the Alliance for Physical Therapy Quality and Innovation (APTQI) showed that an increase in PT among Medicare patients could reduce health care spending by $10 billion.
PT users were 50% less likely to visit the emergency room or be hospitalized for a follow-up injury in the six months following their initial fall, according to the study.
An important distinction, however, is that the data tracked users who had already experienced a fall.
“A lot of people are going to end up in home health because after you fall, you may be homebound for a bit,” Nikesh Patel, executive director of APTQI, told Home Health Care News. “I think what this shows is that whatever setting those PT sessions are happening post-fall, you’re going to have a significant decrease in the likelihood of falls in the next six, 12 and 18 months.”
The results confirm what physical therapists have known for a long time, Patel said: that PT is a safe and effective method for helping seniors build the strength and other necessary skills to avoid future falls and reduce costly expenditures.
The U.S. Centers for Medicare & Medicaid Services (CMS) implemented PDGM on Jan. 1, 2020. Prior to PDGM, home health agencies were paid per therapy visit under the home health benefit in Medicare Part A. Now, payment is tied to patient characteristics.
At the beginning of 2020, many believed there would be an inevitable disruption to home health therapy utilization.
Today, it’s still unclear exactly how PDGM has impacted therapy utilization. Following the implementation of the new payment model, providers were naturally less likely to offer therapy services because they were not as incentivized to do so.
The study’s findings are another example of how PT can offer savings to the entire health care sector.
“For me, the most telling statistic was that for every 100 Medicare beneficiaries, we average in the U.S. about 21 hospital stays,” Patel said. “Of those hospital stays, 40% of those are fall-related. If you have a decrease of four to six hospitalizations and inpatient stays for a year, the costs are staggering.”
According to the study’s authors, increased PT use by 100 beneficiaries prone to falls could result in an offsetting reduction in total health care spending of as much as $61,400 to $91,900 per member.
When considering the 13.5 million Medicare beneficiaries who are not enrolled in physical therapy, that could create $10 billion in savings.