The therapy threshold within the Medicare prospective payment system: Associated ethical dilemmas and influence to therapy practice patterns and quality of patient care

This mixed-method descriptive study analyzed the relationship between the therapy threshold within the Medicare prospective payment system (PPS) and therapy practice patterns, the ethical dilemmas introduced for therapists, and the ultimate quality of patient care. The research included interviews with rehabilitation managers and administration of a therapist questionnaire presenting a Likert-type response scale. This study is significant because, to date, no empirical research has been conducted at the therapist level addressing this topic. The population sample included therapists and therapy managers from seven home health agencies within the northeastern region of the state of Pennsylvania. This research found that the therapy threshold within the Medicare PPS for home health does affect practice patterns. Practice patterns are not affected by agency policy or manager influence, but by the threshold number of visits. Additionally, the threshold does not consistently create an ethical dilemma for therapists, but it does present an ethical dilemma when approaching the threshold for these professionals. The therapy threshold does not negatively affect the quality of patient care nor cause underutilization of services. Further research is needed to verify the findings of this study and to determine when the Medicare PPS for home health is placing therapists in a situational-ethics dilemma. The implications of this study for positive social change are significant. Home-health agencies must instill a climate that encourages therapists to place the needs of patients first rather than focusing on the therapy threshold. These findings also quiet concerns of the Office of the Inspector General and other regulatory bodies over potential ethical concerns arising from the threshold, and lend support to the value of the threshold controlling utilization. Finally, The Health Care Financing Administration should reconsider use of the threshold as the sole indicator of a therapy-intensive patient, which potentially causes a situational-ethics dilemma for therapists.