In-Home Therapy after Knee Replacement

In-home physical therapy (PT) helps knee replacement patients recover more successfully, with six to nine PT visits being a generally optimal level of treatment.

That’s according to research findings from the University of Colorado School of Medicine, recently published in the Journal of Bone and Joint Surgery. A team of physical therapists analyzed Medicare home health claims for patients who received total knee arthroplasty in 2012 and subsequently had in-home rehabilitation.

The review involved nearly 6,000 Medicare beneficiaries.

Individuals who received fewer than five home health visits from a physical therapist had more problems in resuming activities of daily living, the researchers found.

The results of this study have implications for a bundled payment model known as Comprehensive Care for Joint Replacement (CJR). In this program — mandatory in certain markets identified by the Centers for Medicare & Medicaid Services (CMS) — hospitals are responsible for managing costs for a full 90-day care episode for orthopedic patients, including their surgery and post-acute rehab.

Because therapy is more costly to provide in inpatient settings such as skilled nursing facilities (SNFs), CJR hospitals are incentivized to route more patients directly home after surgery.

However, if these patients do not receive appropriate levels of at-home PT, they could be at higher risk of a re-hospitalization — and being readmitted to the hospital drastically drives up the episodic cost of care.

Generally, patients in rural areas and who have other complex medical conditions receive fewer home health visits, the researchers found.

“Our study may help care providers prescribe more optimal dosages of at-home physical therapy for these patients who are discharged,” said lead author Jason R. Falvey, Ph.D., in a post on the CU School of Medicine website. “ … The risks of not providing the appropriate level home health care may result in higher overall health care costs in the long term.”

Adding a further wrinkle: The proposed Patient-Driven Groupings Model (PDGM) would change the Medicare home health payment framework to dis-incentivize high volumes of therapy.

Written by Tim Mullaney

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