A majority of frail Medicare patients who enter nursing homes in need of rehabilitation therapy now receive higher-paying intensive therapy before they leave, a major shift from just years ago, despite no evidence that such therapy is needed. The shift makes the rehab arena an attractive target for Congress and federal health officials looking to save billions of dollars.
HHS' Office of Inspector General last week called on federal policymakers to cut reimbursement for skilled-nursing facilities that deliver rehabilitation therapy, which “could save Medicare billions of dollars.”
The OIG said the use of intensive therapy, which is triggered when physical, occupational, speech or cognitive rehab reaches 720 minutes per week, rose sharply from 2011 to 2013.
While policymakers have been looking at a fundamental overhaul of how Medicare pays for skilled nursing and other post-acute care, many observers now believe Congress could move to make cuts long before those efforts bear fruit. “We're moving toward a tipping point” for reform, said David Grabowski, an expert in long-term care and a health policy professor at Harvard University. Yet more immediate cuts are likely. “We're bound to see some decease in the generosity of payments,” especially for highly profitable, intensive therapy services.