Skilled Nursing Facility Organizational Characteristics Are more Strongly Associated with Multiparticipant Therapy Provision than Patient Characteristics.

OBJECTIVES: Multiparticipant physical and occupational therapy provision has fluctuated significantly in Skilled Nursing Facilities (SNFs) under shifts in Medicare reimbursement policy. Multiparticipant therapy includes group (2-6 patients per therapist) and concurrent therapy (2 patients per therapist). This study uses recent patient-level data to characterize multiparticipant therapy provision in SNFs to help anticipate shifts under new Medicare policy and the COVID-19 pandemic.

METHODS: This secondary analysis used data on 1,016,984 post-acute rehabilitation stays in SNFs in 2018. This analysis identified patient predictors (eg, demographic, clinical) and organizational predictors (eg, ownership, quality, staffing) of receiving multiparticipant therapy using mixed effects logistic regression. Among patients who received any multiparticipant therapy, those patient or facility factors associated with high rates of multiparticipant therapy provision were also determined.

RESULTS: Under 3% of patients received multiparticipant therapy in 2018. Patient functional and cognitive impairment and indicators of market regulation were associated with lower odds of multiparticipant therapy. Effect sizes for organizational factors associated with multiparticipant therapy provision were generally larger compared to patient factors. High multiparticipant therapy provision was concentrated in less than 2% of SNFs and was positively associated with for-profit ownership, contract staffing, and low Five-Star quality ratings.

CONCLUSION: SNF organizational characteristics tended to have stronger associations with multiparticipant therapy provision than patient factors, suggesting that changes in patient case-mix, as expected during the COVID-19 pandemic, may have less of an impact on multiparticipant therapy provision than organizational factors. Results suggest that for-profit SNFs in states with higher market regulation, SNFs providing high volumes of therapy, and SNFs utilizing high proportions of assistants and contract staff may be more responsive to Medicare policy by increasing multiparticipant therapy provision.

IMPACT: This study may help identify SNFs that are more likely to increase multiparticipant therapy provision under new Medicare payment policy.