The financial burden of rehabilitation: Variation in clinician charges and implications for patient financial liability.
40 Background: Occupational and Physical therapies (OT/PT) are effective treatments to decrease disability and functional status. Few studies have examined the variations in the cost of outpatient OT/PT. For adults with cancer, the added financial burden of cancer rehabilitation is unknown. The study objectives were to (1) describe the variation in patient financial burden for the most commonly used OT/PT services by the provider type (either OT or PT) and State; and (2) determine the impact of therapy caps on the price of service provided among Medicare beneficiaries. Methods: This retrospective, population-based study used the Medicare Provider Utilization and Payment Data Public Use File (PUF), released in April 2014 by the Center for Medicare and Medicaid Services (CMS) to examine variations in care by level of insurance (uninsured, insured and reimbursed), between providers and across states with descriptive statistics. We also examined the impact of the therapy cap on number of visits allowed and the proposed reduction of the therapy cap dollar amount on services use and patient out-of-pocket liability. Results: 3,663 (9.2%) OT’s and 36,247 (90.8%) PT’s were included. Differences between provider’s charges were minimal. Wisconsin, Illinois, Tennessee and Texas had the most inflated charges, respectively, for OT and PT. 12-14 visits plus evaluation are covered under 2012 therapy cap, and the amount of visits would be cut to 7-9 with the MedPAC cap. Conclusions: This study suggests there is wide variation between the potential patient liability for the price of OT/PT based on service provided, state received and insurance coverage. For older adults with cancer who need OT/PT services, this will be an additional cost to their care. Patients without insurance pay a premium for OT/PT services.