Hospitals Did Not Increase Acute Occupational Therapy Provision Despite Positive Associations With Hospital Performance Under Medicare’s Comprehensive Care for Joint Replacement Program

These results indicate that hospitals did not increase acute OT as part of their improvement strategy under CJR, despite the potential for acute OT to yield financial returns on investment. Plain-Language Summary: Medicare's Comprehensive Care for Joint Replacement (CJR) bundled payment program rewards hospitals for low Medicare spending from hospitalization through 90 days postdischarge. Although occupational therapy (OT) improves patient-centered care and reduces Medicare spending, it is unknown whether hospitals modified (or targeted) acute OT services when treating older patients who were hospitalized for major joint replacement surgery under CJR. We used national Medicare data to characterize the variation in hospital use of acute OT and to identify how CJR affected acute OT use by hospitals. We then examined whether acute OT use was associated with financial returns on investment by hospitals in CJR. We found that acute OT use did not change under CJR, even though higher OT use was correlated with larger financial rewards for CJR hospitals. Future research should focus on quantifying the value-added of OT on patient outcomes and Medicare spending.