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PubMed · 15148049

Does payment structure influence change in physical functioning after rehabilitation therapy?

George R Shannon·Judy Y Yip·Kathleen H Wilber
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Abstract

PURPOSE: 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.

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Activities of Daily LivingAgedAged, 80 and overCaliforniaFee-for-Service PlansHealth Services ResearchHumansManaged Care ProgramsMedicareRehabilitationReimbursement MechanismsTreatment OutcomeUnited StatesJournal ArticleResearch Support, Non-U.S. Gov't

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George R Shannon, Judy Y Yip, Kathleen H Wilber. 2004. Does payment structure influence change in physical functioning after rehabilitation therapy?. https://doi.org/10.1300/j027v23n01_04

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