Research Article  |   January 2018
Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region
Author Affiliations
  • Mackenzi Pergolotti, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Services, Colorado State University, Fort Collins; m.pergolotti@colostate.edu. At the time of this research, she was Postdoctoral Fellow, Cancer Care Quality Training Program, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
  • Jessica Lavery, MS, is Assistant Research Biostatistician, Memorial Sloan Kettering Cancer Center, New York, NY. At the time of this research, she was Graduate Assistant, Department of Statistics and Operation Research, University of North Carolina at Chapel Hill
  • Bryce B. Reeve, PhD, is Professor, Department of Population Health Sciences, and Director, Health Measurement Center, Duke University Medical Center, Durham, NC. At the time of this research, he was Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
  • Stacie B. Dusetzina, PhD, is Assistant Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Article Information
Advocacy / Complementary/Alternative Approaches / Research Articles
Research Article   |   January 2018
Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region
American Journal of Occupational Therapy, January 2018, Vol. 72, 7202205050p1-7202205050p9. doi:10.5014/ajot.2018.023796
American Journal of Occupational Therapy, January 2018, Vol. 72, 7202205050p1-7202205050p9. doi:10.5014/ajot.2018.023796
Abstract

OBJECTIVE. This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps.

METHOD. This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs.

RESULTS. Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12–14 visits.

DISCUSSION. Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.