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- Title
The effect of insurance type on Medicare functional outcomes in skilled nursing facilities: a secondary data analysis.
- Authors
Kroll, Christine; Martin, Tara; Menke, Brenna; West, Anne Mari; Wilkins, Faith; Woo, Madison
- Abstract
Background/Aims: Section GG consists of Medicare developed functional outcome assessments used in all post-acute care interdisciplinary assessments. This study used Section GG functional performance measures to evaluate correlations between rehabilitation treatment time, patient self-care and mobility outcomes to assess the significance of functional outcome measures in post-acute care settings considering the current reimbursement system, type of medical insurance (Medicare or Medicare Advantage) and length of stay. Methods: A secondary analysis was undertaken of a medical dataset collected from 93 skilled nursing facilities in the mid-west region of the USA (n=1352) using the Statistical Package for the Social Sciences (version 27.0). Descriptive statistics were used to find differences related to the type of insurance. General linear regressions were used to discover significant relationships among functional scores and the independent variables. Results: The study identified relationships between insurance type, length of treatment and diagnostic category in a skilled nursing facility based on Medicare beneficiaries. There was a significant positive relationship between insurance and length of treatment where patients with Medicare had more treatment days in therapy as a result of a longer stay (mean days: 22) than those with Medicare Advantage Plans (mean days: 15) (P=0.001). The data showed a positive correlation between length of treatment and self-care and mobility functional outcomes (P=0.01). Conclusions: The study found that changes in reimbursement systems led to reduced provision of therapy services, making the length of therapy treatment during the stay a critical factor. Functional outcome changes were higher among Medicare beneficiaries as measured by standardised Section GG measurements in post-acute care, compared with Medicare Advantage Plans, with length of treatment being a strong differentiator. Implications for practice: This study highlights the importance of the type of Medicare insurance and the effect it will have on patients' functional outcomes as affected by the length of stay. Those patients with traditional Medicare have a statistically longer length of stay and thus higher functional outcomes on discharge, improving chances for a safe and sustainable return to the community. Those clients with a Medicare Advantage plan may need more intensive therapy (more time per session) to make the same functional gains before being discharged.
- Subjects
MIDWEST (U.S.); HEALTH self-care; STATISTICAL correlation; PHYSICAL therapy; SECONDARY analysis; HEALTH insurance reimbursement; DATA analysis; STATISTICAL hypothesis testing; FUNCTIONAL assessment; REHABILITATION; HEALTH insurance; MEDICARE; MEDICAL care; MULTIPLE regression analysis; TREATMENT duration; DESCRIPTIVE statistics; NURSING care facilities; SUBACUTE care; OCCUPATIONAL therapy; PRE-tests & post-tests; STATISTICS; LENGTH of stay in hospitals; DATA analysis software; PHYSICAL mobility; REGRESSION analysis
- Publication
International Journal of Therapy & Rehabilitation, 2024, Vol 31, Issue 12, p1
- ISSN
1741-1645
- Publication type
Academic Journal
- DOI
10.12968/ijtr.2023.0041