Nursing homes have billed for increasing therapy levels each year since Medicare began paying for duration of therapy in 1998, according to a Wall Street Journal analysis of federal financial reports.
The analysis revealed the percent of days nursing homes billed Medicare for giving patients "ultrahigh" levels of therapy — 720 minutes or more of physical therapy per week — has increased from about 7 percent in 2002 to 54 percent in 2013.
Therapy rates vary greatly based on region, and nursing homes with the most ultrahigh therapy levels are concentrated primarily in California, Florida, Nevada and Utah, according to the report. For example, Orange County, Calif., nursing homes had a 71 percent ultrahigh therapy rate in 2013, compared to 27 percent of patients in Des Moines, Iowa.
Ultrahigh levels of therapy were reimbursed on average $560 per day in 2013, compared to "very high" levels of 500 to 719 minutes, which were reimbursed an average of $445 per day, or "low" levels of 45 to 149 minutes per day, which were reimbursed $325 per day, according to the report.
The Wall Street Journal also reported more than two dozen current and former therapists and others involved in nursing home care said caregivers were pressured to meet the ultrahigh threshold of therapy by managers.
"Playing to the max has a long tradition in healthcare," Vincent Mor, PhD, chairman of the independent quality committee at Toledo, Ohio-based HCR ManorCare, told WSJ. He added, "That tradition is based on the number of minutes of therapy given, so people give therapy up to the max."
Dr. Mor also told WSJ sicker patients in nursing homes could be a factor in the rising levels of therapy. Other factors noted in the report that could contribute to rising levels of therapy are increasingly-informed patients, more thoroughly documented treatment and patients are sent to nursing homes sooner after surgery.
HCR ManorCare, one of the country's largest operators of nursing homes, billed for ultrahigh levels of therapy 68 percent of the time in 2013, up from 8.8 percent in 2002. The company did not comment, but it was involved in a lawsuit last December alleging it pressured its employees to give unnecessary therapy, according to the report.
More articles on finance:
IASIS Healthcare suffers $1.7M loss in Q3
Medicare's voluntary bundled payment program grows by 2,100 participants
11 recent hospital outlook and rating actions