Physical Therapy Proven to Pay Off for Home Health Dementia Patients

Physical therapy (PT) has the ability to improve activities of daily living (ADLs) and functional ability for Medicare home health beneficiaries with dementia, a recent study published by the Journal of the American Geriatrics Society has found. The findings stand as a reminder of the value of PT services, despite ongoing changes under the Patient-Driven Groupings Model (PDGM) and shifting strategies among providers.

As part of the study, researchers examined Centers for Medicare & Medicaid Services (CMS) data from 2012, focusing on 1,477 older adults age 66 and up who had a primary diagnosis of dementia and received home health care services.

Overall, researchers found that Medicare home health beneficiaries with dementia who received zero PT had a 60% chance of seeing ADL improvement. Those who did receive PT services had a 75% chance of seeing improvement — a substantial boost.


Additionally, the likelihood of ADL improvement increased with the amount of PT visits the patients had. Patients who received six to 13 visits were roughly 80% likely to see improvement. For those who received 14 or more visits, this jumped to roughly 88%.

In general, the study’s findings serve as an argument against home health providers implementing wholesale therapy cuts in the wake of PDGM.

As the home health industry continues to settle into PDGM and it’s fundamental changes to therapy visits and reimbursement, providers may feel tempted to severely gut therapy utilization.


Indeed, therapy volume no longer automatically drives payment under PDGM. It’s now largely determined by patient characteristics and outcomes.

Researchers noted that the payment overhaul may hinder the quality of care for dementia patients.

“These factors may produce downward pressure on home health rehabilitation services utilization, generally discouraging therapy use and potentially increasing avoidable function decline for [persons with dementia],” the authors wrote in the study.

While some providers have made plans to lower therapy utilization this year — possibly as many as roughly 25% of providers — companies like LHC Group Inc. (Nasdaq: LHCG) say that they have held off on blunt cuts.

“We are not seeing a reduction in visits, but we are seeing a change in the visit mix that we deliver to the patients,” Keith Myers, LHC Group chairman and CEO, said earlier this month during a presentation at J.P. Morgan’s annual health care conference. “We are able to use extenders more than we were in the past.”

Similarly, Encompass Health Corporation (NYSE: EHC) has not made drastic cuts to therapy, with leadership saying the company hasn’t had any related layoffs post-PDGM either.

“We’ve had zero layoffs of therapists,” April Anthony, CEO of Encompass Health’s home health and hospice business, previously told Home Health Care News. “We’ve had zero changes in compensation to our therapy, our visit approach. Any of that. We really feel like the whole therapy-behavior change is over-cooked. We have seen a change in methodology driven by our analytics tools. Some patients are getting far more therapy visits while others are getting far fewer — but on balance.”

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