Hospitals Did Not Increase Acute OT Provision Despite Positive Associations With Hospital Performance Under Medicare’s CJR Program

PURPOSE: Medicare’s Comprehensive Care or Joint Replacement (CJR) program rewards hospitals for reducing total Medicare spending. Despite benefits of OT on patient outcomes and spending, little is known about how CJR affected hospital provision of acute OT services. This study was completed to determine if CJR changed acute OT provision, and if higher acute OT provision was associated with CJR rewards.

DESIGN: A cohort study comparing acute OT provision in 722 hospitals randomly selected for treatment under CJR with 859 hospitals in the control group, before and after CJR was conducted. A linear regression with a difference-in-difference design was used to estimate the average change in acute OT outcomes, comparing hospitalizations and 140 control metropolitan statistical areas before and after CJR.

METHOD: The association between acute OT use and CJR financial rewards among 606 CJR hospitals was assessed. Setting: Medicare major joint replacement surgery discharges (n=1,006,938) between 2014 and 2018 in the United States. National Medicare inpatient claims data were used to examine diagnoses and per-hospitalization acute OT provision (OT costs, patient receipt of OT, and OT share of hospitalization costs). CJR program files were used to determine hospital rewards.

RESULTS: CJR did not affect acute OT provision in terms of prehospitalization OT costs, patient receipt of OT, or OT share of total hospitalization costs. Each additional dollar of OT spent by hospitals was associated with an increase of $1.99 CJR reward dollars.

CONCLUSION: These results indicate that hospitals did not incorporate acute OT as part of their improvement strategy under CJR, despite the potential for acute OT to yield financial returns on investment. OT practitioners should articulate the potential financial benefits of increased acute OT provision to hospitals. Supporting evidence can assist in advocating for an increase in OT services for older populations.

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