Integration of Rehabilitation Care from the Acute to Community Setting: The Role of Physician Referral

Investigators: Janet Freburger, PT, PhD (no longer at The Sheps Center)

Background

Physical therapy is effective in the treatment of many musculoskeletal and neurologic conditions.(1-5) Medicare, some state Medicaid programs, and some private insurers require a physician referral for patients to receive care from a physical therapist in outpatient or ambulatory settings. New care delivery (e.g., PCMHs, ACOs, etc.) and payment models (e.g., bundled and value-based payments that incentivize integration of care across acute and post-acute settings) put increased emphasis on the role that physicians play in facilitating patient access to physical therapists in outpatient settings. In an earlier project, supported by the the National Center for Health Workforce Analysis, we found that timely receipt of therapist care in the community (i.e., either in the home or outpatient setting) following hospital discharge after stroke decreased the risk of rehospitalization and that primary care physician supply in the patient’s county of residence was one of the most consistent predictors of timely receipt of therapist care. We also found evidence of socioeconomic disparities in physical therapist use following hospital discharge.

Specific Aims

This project proposes to further explore the physician’s role in referral to physical therapists in ambulatory care settings by using two population-based data sources: The National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). Specifically, we will examine 10 years of data (2004-2013) to achieve the following specific aims:

  • Describe ambulatory care physicians’ referrals to physical therapists by identifying: a) the common diagnoses/reasons for referral; b) the demographic and payment source characteristics of patients referred; c) the types of physicians most likely to refer to physical therapists; and d) other relevant patient characteristics (e.g., presence of chronic conditions, medication use, etc.).
  • Describe temporal trends in referral to physical therapists for the entire sample and stratified by relevant subgroups (e.g., sex, race, payment source).
  • For the more commonly identified reasons for referral to physical therapists, identify physician-level (e.g., specialty, setting, geography, and organizational characteristics) and patient-level (e.g., sociodemographic characteristics) predictors of referral, controlling for clinical characteristics (e.g., prior hospitalization, presence of chronic conditions) and condition severity.