Percentage of Beneficiaries Exceeding Risk-Adjusted and Non–Risk-Adjusted Annual Physical Therapy Expenditure Cap, by Diagnosis and Mobility Groupa
↵a The risk-adjusted cap is predicted from the quantile regression for the 70th percentile of annual physical therapy expenditures (Tab. 2). The non–risk-adjusted cap is our simulated 2011 physical therapy–specific budget-neutral cap of $1,710 (Tab. 3). Actual annual physical therapy expenditures are compared with the caps to determine the percentage of beneficiaries using physical therapist services with expenditures above the cap. Expenditures are Medicare allowed charges. The analysis uses a convenience sample (N=4,210) of community-residing Medicare beneficiaries who presented for physical therapy at a provider participating in data collection during a specified 12-month period. Source: authors' analysis of 2011 Medicare claims and enrollment and Developing Outpatient Payment Alternatives (DOTPA) data.