Postoperative hand therapy and the 2018 Medicare therapy cap repeal: Appraising cost and use changes.
Joseph N Fahmy, Lingxuan Kong, Lu Wang and 1 others
PMID 38942653WHAT IT FOUND
The 2018 Medicare therapy cap repeal reduced out-of-pocket costs by about $1 per appointment but led to increased therapy use after carpal tunnel and distal radius fracture surgeries.
This suggests coverage changes may drive utilization more than clinical need, potentially requiring prior authorization to balance access with appropriate care.
Key findings
01Out-of-pocket costs per therapy appointment decreased by approximately $1.01 for white patients and $1.52 for non-white patients immediately after the policy repeal.
02White patients were 10% more likely to receive postoperative hand therapy immediately following the policy implementation.
03Patients undergoing carpal tunnel release and trigger finger release experienced a 12% and 18% increase in the odds of receiving any postoperative therapy, respectively, immediately after the policy change.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied on administrative claims data which lacks clinical detail, so it could not account for disease severity or specific patient needs that might legitimately drive therapy utilization. There was no control group unaffected by the policy, so the study uses a quasi-experimental design that assumes temporal changes are linked to the policy implementation. The findings apply only to patients undergoing common outpatient hand surgeries and may not generalize to other medical fields or more complex surgical cases. Race was categorized broadly as White or non-White due to sample size constraints, which may mask specific disparities among individual racial or ethnic groups.
Declared interests
Dr. Fahmy receives support from an institutional surgeon-scientist training grant from the National Institutes of Health and grants from the Plastic Surgery Foundation and American Foundation for Surgery of the Hand, outside of the submitted work. Mr. Kong and Dr. Wang have no financial disclosures to report.
The easy way to misread this
Do not conclude that the therapy cap repeal significantly improved financial access for patients, as the reduction in out-of-pocket costs was minimal (about $1 per appointment) and costs began rising again in the post-policy period. The primary effect observed was an increase in therapy utilization, not a major economic relief for beneficiaries.