This study examined billing, reimbursement, and administrative outcomes of the HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program. This pilot study involved 6 participants and 4 different insurances. 

Key findings include, but are not limited to:

  1. Cost Analysis: The average payment for initial evaluations was $102.83, while treatments averaged $25.90 per unit. The outpatient therapy billing model was utilized. 
  2. Operating Margin Potential: Initial pilot data indicated a potential operating margin of 4.2% when considering salary costs and travel expenses, suggesting that such programs can be financially viable with efficient operations.
  3. Authorization Delays: The mean delay for physician authorization from referral to the HOP-UP-PT program was 69.7 days, posing a significant barrier to timely access to prevention-focused physical therapy services.
  4. Impact of Telehealth on Viability: If telehealth services had been reimbursed, the operating margin could have increased to 32%, emphasizing the importance of policy clarity regarding telehealth in enhancing the sustainability of such programs.

Article Abstract: Wilson CM, Arena SK, Calleja K, et al. (August 20, 2024) Administrative Analysis of the Home-Based Older Persons Upstreaming Prevention Physical Therapy Program: A Pilot Observational Study. Cureus 16(8): e67290. doi:10.7759/cureus.67290