Frontloaded Home Health Physical Therapy Reduces Hospital Readmissions among Medicare Fee-for-Service Beneficiaries

Abstract Objective The purpose of this paper is to determine a claims-based definition of frontloaded home health physical therapy (HHPT) and examine the effect of frontloaded HHPT visits on all-cause 30-day hospital readmissions. Methods This study used a retrospective analysis of Medicare fee-for-service claims from older adults (≥65 years) in the National Health and Aging Trends Study (NHATS; 2011–2017) with ≥1 HHPT visit within 30 days of a hospitalization (n = 1344 hospitalizations; weighted n = 7,727,384). An exploratory analysis of home health claim distribution was conducted to determine definitions of frontloaded HHPT. Generalized linear models were then used to examine the relationship between hospital readmission and each definition of frontloading. Results Four definitions of frontloaded HHPT were identified: ≥2 HHPT visits in the first week after discharge; ≥3 visits in the first week; ≥4 visits in the first 2 weeks; and ≥ 5 visits in the first 2 weeks. The adjusted risk of readmission was lower for older adults receiving frontloaded HHPT in the first week: (risk ratio RR for ≥2 vs 2 visits = 0.57; 95% CI = 0.41–0.79; RR for ≥3 vs 3 visits = 0.39; 95% CI = 0.22–0.72). The reduction in risk of readmission was even greater for older adults receiving ≥4 versus 4 HHPT visits (RR = 0.32; 95% CI = 0.21–0.48) and ≥ 5 versus 5 HHPT visits (RR = 0.27; 95% CI = 0.14–0.50) within the first 2 weeks. The effect of HHPT frontloading was greater for patients hospitalized with surgical versus medical diagnoses and for patients with diagnoses targeted by the Hospital Readmissions Reduction Program. Conclusion Frontloaded HHPT reduces 30-day hospital readmissions among Medicare beneficiaries. Additional research is needed to determine the optimal number of visits and those most likely to benefit from frontloaded HHPT. Impact Frontloaded HHPT can be an effective approach for reducing 30-day hospital readmissions among Medicare beneficiaries.