A new study reveals a growing trend of potentially unnecessary and harmful high-intensity rehabilitation services for residents of healing homes. The study finds that this trend, which may be driven by a desire to maximize reimbursement rates, is on the rise for patients in the last 30 days of life, indicating that these services may be interfering with appropriate end-of-life care.

The study was published in the  Journal of the American Medical Directors Association.

This study raises several concerns and questions regarding the scope and intensity of therapy provided to nursing home residents Prior to death. If it is being driven by a failure to recognize that a resident is approaching end-of-life, then it calls for improving the skills of nursing home teams.

Nursing home Medicare reimbursement rates are based on categories that place patients into resource utilization groups (RUGs) based on the complexity, intensity, and amount of staff time dedicated to their care .

Rehabilitation Services

Patients who receive high levels of rehabilitation services fall into a category that makes these facilities eligible to collect the highest level of reimbursement for their care. This phenomenon has been on the radar of federal regulators for some time.

The OIG has also indicated that this data suggests that some nursing homes may be exploiting the payment system for rehabilitation services to "optimize their revenues." The authors of the current study analyzed data from 647 nursing home facilities in New York better understand the patterns and growth of rehabilitation services.

Specifically, they focused on residents who had received very high to ultrahigh rehabilitation services-physical, occupational, and speech therapy during the last 30 days of life. Look and high-intensity rehabilitation is defined as 520 minutes or greater per week and ultrahigh as 720 minutes or greater or the equivalent of two hours of rehab per day  high-intensity rehabilitation is defined as 520 minutes or greater per week and ultrahigh as 720 minutes or greater or equivalent of two hours of rehab per day.

They found that residents receiving ultrahigh rehabilitation had increased by 65% ??between 2012 and 2015 and that most of the rehabilitation therapy was received in the last seven days of life. They also found that there was a significantly higher use of these services in for-profit nursing.

Nursing Home

They also found that there was a significantly higher use of these services in the for-profit nursing home . While the study only included data from New York State, the authors contend that this phenomenon is likely to be more pronounced in other states, which have lower nursing home regulatory oversight.

A 2013 CMS study showed that nursing homes in at least 17 other states billed for ultrahigh-intensity rehabilitation services at rates higher than New York State. The authors acknowledge that some level of rehabilitation may be necessary and appropriate for patients approaching the end-of-life, such as speech therapy, which can assist with difficulties in swallowing.

Hospice & Palliative Care

These are often sick and frail patients in whom the risks of increasing levels of rehabilitation actually outweigh the benefits. It can increase the burden of pain and exhaustion experienced by patients and contribute to their suffering. More worryingly, the focus on maximizing rehabilitation may represent an unnecessary barrier to the timely introduction of hospice and palliative care.