Prospective payment for nursing homes increased therapy provision without improving community discharge rates

OBJECTIVES: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities (SNFs) on therapy use and community dischar ge rates. DESIGN: Quasi-experimental study examining the pre-demonstration (1994) to demonstration (1997) change in amount of therapy provided, and in community discharge rates at PPS participating and nonparticipating facilities. SETTING: Eighteen PPS participating and 17 nonparticipating SNFs in five st ates. PARTICIPANTS: Two thousand sixty-seven admissions to 18 PPS participating a nd 17 nonparticipating SNFs in five states. MEASUREMENTS: We compared changes in number of physical and occupational th erapy visits per stay for patients receiving therapy and likelihood of bein g located in the community 60 days after admission between 1994 and 1997. A nalyses were stratified by functional category and risk adjusted using mult ivariate methods. RESULTS: Demographics and percentage of patients in each stratum were simil ar in participating and nonparticipating sites and between 1994 and 1997. A mount of therapy received by the highest-functioning patients increased in participating sites (19.3 to 26.5 visits per stay, P = .005), but not in no nparticipating sites (23.3 to 18.2, P = .98). After adjusting for covariate s, likelihood of community discharge for the highest-functioning patients d id not change between participating and nonparticipating sites. CONCLUSIONS: The highest-functioning patients treated under the SNF PPS dem onstration experienced great increases in therapy, without any improvement in rate of community discharge.