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Increase in utilization, cost of physical therapy found following primary TJA
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Researchers of a recently published study found an increase in the utilization and costs of physical therapy between 1997 and 2010, as more patients who underwent primary total joint arthroplasty were discharged home with home health services or to skilled nursing facilities.
“Physical therapy modalities may be individualized for each patient, but greater attention should be placed on whether certain therapy modalities are effective in improving patient outcomes, speeding recovery and reducing complications such as dislocation, instability and implant revision,” Kevin L. Ong, PhD, PE, told Orthopedics Today.
Physical therapy
Using the 5% Medicare database, Ong and his colleagues identified 50,886 patients who underwent primary total hip arthroplasty (THA) and 107,675 patients who underwent primary total knee arthroplasty (TKA). Researchers evaluated the prevalence of physical therapy after hospital discharge, as well as the associated costs among all patients within 12-months postoperatively.
Regardless of the subsequent discharge pathway, Ong and his colleagues found the most common in-hospital length of stay was 3 days. In addition, they found nearly all patients discharged to nursing facilities had hospital stays of 3 days. Results showed an increased trend toward discharge to home with home health services over time, while discharge to rehabilitation facilities declined sharply through 2009.
Physical therapy in the home health setting was delivered to 44.6% of patients who underwent primary THA and to 40.7% of patients who underwent primary TKA, according to study results. Within the first year post-discharge, the researchers noted the most prevalent physical therapy modalities were range of motion/strength training and mobilization/mechanical traction. The researchers also noted less common physical therapy modalities were being utilized in a substantial portion of patients.
“The wide variety of physical therapy modalities that are prescribed is surprising, as are the trends in the discharge status that seem to follow a change in reimbursement policies,” Ong said.
Increase in annual costs
According to study results, the estimated annual cost of physical therapy was $648 million in 2009, with increases to $180.4 million for primary THA and $468 million for primary TKA between 1998 and 2009. During the study period, results showed an increase in the average annual physical therapy cost per patient in contrast to hospital and surgeon reimbursement and implant costs. When it came to home health settings, primary THA accounted for 72.6% of the total physical therapy cost and primary TKA accounted for 60.3%.
“[Physical therapy] PT after joint replacement surgery is used extensively. The total PT costs are rising at a faster rate than the increase in cases performed and are a significant factor in the overall costs of total joint replacement [TJR],” Ong said. “The effectiveness of a number of physical therapy modalities is unclear, yet these modalities comprise a substantial proportion of the overall physical therapy costs.” – by Casey Tingle
- Reference:
- Ong KL, et al. J Arthroplasty. 2015;doi:10.1016/j.arth.2015.02.030.
- For more information:
- Kevin L. Ong, PhD, PE, can be reached at Exponent Inc., 3440 Market St. #600, Philadelphia, PA 19104; email: kong@exponent.com.
Disclosure: Ong reports he is an employee and shareholder of Exponent and is a consultant for Ferring Pharmaceuticals Inc., Stryker Orthopaedics, Biomet, Paradigm Spine, Pacira Pharmaceuticals, Medtronic, Stryker Mako Surgical, Ethicon and Zimmer.