Key result
Declining therapy volumes in skilled nursing facilities linked to fewer community discharges and higher 30-day readmissions.
Why the study?
Significant declines in therapy provision in SNFs followed the 2019 Medicare PDPM implementation and COVID-19 pandemic, raising concerns about effects on patient outcomes.
Do declining therapy volumes reduce successful community discharge and increase 30-day hospital readmissions in post-hospital SNF stays?
Observational (n=3,500,000)
Yes
Do declining therapy volumes reduce successful community discharge and increase 30-day hospital readmissions in post-hospital SNF stays?
Declining therapy volumes in skilled nursing facilities are strongly associated with worse post-acute outcomes, including lower community discharge rates and higher 30-day readmissions.
Answers are grounded in this paper and cite their sources.
Should not yet change SNF therapy practices; extends observational evidence on volume-outcome links.
Introduction Significant declines in therapy provision in skilled nursing facilities (SNFs) followed the 2019 implementation of Medicare’s Patient-Driven Payment Model (PDPM) and the onset of the COVID-19 pandemic, raising concerns about effects on patient outcomes. Methods Using Medicare fee-for-service claims and SNF assessment data from January 2018 through September 2021, we analyzed 3.5 million post-hospital SNF stays to assess whether changes in therapy volumes mediated changes in successful community discharge and 30-day hospital readmissions. Results Average total physical, occupational, and speech therapy minutes per day declined from 122.2 before PDPM to 96.5 immediately after implementation and to 87.7 during the pandemic. Adjusted probabilities of successful community discharge rose modestly after PDPM but fell during COVID-19, while readmissions declined initially and then increased. Mediation analyses showed that reductions in therapy volumes were strongly associated with the declines in community discharge and increases in readmissions. These findings persisted for patients with dementia and moderate levels of functional impairment at admission; declining therapy volumes were associated with the observed worsening of discharge outcomes after PDPM implementation and during the pandemic. Conclusions Results highlight therapy provision as a key modifiable policy target for improving post-acute outcomes and reducing rehospitalizations among older adults in SNFs.
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Prusynski et al. (2026) conducted an observational in Post-hospital skilled nursing facility stays (n=3,500,000). Declining therapy volumes vs. Baseline therapy volumes was evaluated on Successful community discharge and 30-day hospital readmissions. Declining therapy volumes in skilled nursing facilities (from 122.2 to 87.7 minutes/day) were strongly associated with worsened successful community discharge and increased 30-day readmissions.
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