Abstract Body: Introduction
Rehabilitation is essential to stroke recovery; however, access to rehabilitation varies in the US. We report recent national utilization rates of different rehabilitation disciplines in stroke survivors covered by different payors in the US. There is uncertainty how utilization equates to actual number of therapy sessions.
Methods
This is a retrospective, population-based, observational study using claims data of the Merative™ MarketScan® commercial database and the 5% national sample of Medicare Fee-For-Service (FFS) claims for ischemic and intracerebral hemorrhage (ICH) stroke hospitalizations among US adults aged 18 years and older during the period from 2016 to 2020. The study outcome was a new speech pathology (SLT), occupational therapy (OT), or physical therapy (PT) encounter during the first year after discharge.
Results
57,647 total cases were identified with 30% Medicare FFS, 33% Truven (Commercial) Medicare Advantage plan (65 years and older), and 37% Truven commercial (less than 65 years old). Stroke sequela included hemiplegia 52%, aphasia 23%, dysphagia 17%, and cognitive impairment 14%. Figure 1 shows the visits (mean) per discipline over time. The highest visits among all disciplines were for PT and the payor covering the highest number of services was Medicare FFS at all time points: 30 days (mean 2.02, SD 3.04), 90 days (mean 4, SD 6.01), and at 1 year (mean 8.25, SD 12.8). For all services covered by payors, PT had the most visits (39%) followed by OT (30%), and SLT (22%) and 9% of cases could not be differentiated as either PT or OT.
Conclusions:
Utilization based on the number of outpatient visits is abysmally low in all rehabilitation disciplines in the time frame when the brain is maximally responsive to rehabilitation therapy despite documented impairments. Our results are consistent across 3 different payors demonstrating that rehabilitation therapy is grossly underutilized over the first year after stroke in all payor groups in the US.