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Hi Timeless Autonomy Community,

I promised to write about hospital mobility programs.

I’m a big believer.

Partly because I’m a physical therapist.

Partly because I believe in doing what’s best for patients.

I believe they should maintain the ability to walk and get up from a chair unless mobility is contraindicated.

I also believe hospitals would all have robust mobility programs if they were a direct source of revenue.

I believe hospitals should be reimbursed in a way that incentivizes them to take full responsibility for what I think is a fiduciary duty to patients. That would include taking maintenance of mobility as a fundamental expectation of hospitals.

Hospital mobility is crucial for optimal long-term patient outcomes.

Patients who remain mostly on bedrest or “chair rest” in hospitals deteriorate rapidly. They experience muscle weakness, increased susceptibility to secondary infections, depression, exacerbation of dementia, heightened anxiety, and host of other negative sequalae.

So why do some hospitals permit immobility when it's clearly detrimental to patients?

What's best for patients—such as early mobility and comprehensive rehabilitation—doesn't directly boost hospital reimbursement.

Hospitals receive payment based on the final Diagnostic-Related Group (DRG) assigned by the coding team at the end of a patient's stay. This DRG is determined by matching the patient's most intensive condition and the complexity of treatment provided during their hospitalization.

The extent to which a patient's mobility is preserved, improved, or lost during their stay has no impact on the hospital's DRG payment.

What's best for patients also doesn't affect physician reimbursement.

Said another way, physician and other provider compensation is not related to patient outcomes.

And unfortunately, the direct financial incentive in the business of healthcare in fee-for-service is really to provide the care that optimizes reimbursement to providers.

Read more about why I’m so passionate about value-based care here:

Who pays for hospitalizations?

The Centers for Medicare and Medicaid Services are the primary payers for hospitalizations in the United States. They reimburse hospital stays under Medicare Part A and physician services during the hospital stay under Part B, using the Place of Service code for hospital inpatient services. CMS also pays for Medicaid beneficiaries’ stays.

Various physicians bill for care during a hospital stay, including hospitalists, surgeons, intensivists, advanced practice providers (nurse practitioners, physician assistants, and clinical nurse specialists), and other consulting medical specialists.

Other healthcare providers, such as physical therapists and registered dietitians, do NOT bill Medicare for their inpatient services like they do in outpatient settings.

So the two revenue-generating service types in the hospital inpatient setting are the Medicare Part A DRG payment and the Medicare Part B physician payments. Some of these hospital-billing providers also refer patients directly to the hospital. Surgeons, for instance, may only practice at one or two local hospitals, and these hospitals rely on them for high-revenue-generating procedural DRGs.

Other healthcare professionals’ care is a cost center for the hospital.

Since no revenue is associated with physical therapists, occupational therapists, speech therapists, dietitians, social workers, nurses, support staff, and others in the hospital setting, the size of those teams may not align with what’s ideal for patients. I also think the payment structure of the hospital inpatient setting has had other unintended consequences on these professions, but that’s a story for another day.

Unless a hospital is participating in a global budget model (like the Maryland Total Cost of Care Model, the Vermont All-Payer Model, or the new AHEAD Model) or an episodic model (like the Bundled Payments for Care Improvement-Advanced (BPCI-A) Model and the 2026 Mandatory Transforming Episode Accountability Model (TEAM)), there is no incentive to provide all the care and services that would optimize episodic or longitudinal spend, ensure warms hand-offs to the next site of care and optimal, safe transitions of care, reduce readmissions, or do what’s best for the patient’s experience of care.

Hospital mobility programs are a cost center, not a profit center. That matters, because incentives drive most everything.

Hospital mobility programs can play a key role in preventing a host of negative consequences for patients. They:

• Increase the likelihood of discharge to home or home with home health care

• Enhance the probability that an assisted living resident will maintain in their current living situation and not transition to a long-term care facility/skilled nursing facility

• Reduce the likelihood of complications from multiple transitions of care

• Improve patient safety by decreasing the risk of falls

• Minimize the likelihood of secondary complications in inpatient post-acute settings

The Impact of Hospital Mobility Programs

The impact mobility has on patient outcomes is profound and regularly dismissed. Let's explore the benefits of these programs and why I think hospitals should consider investing in them despite the lack of direct financial incentives in fee-for-service healthcare.

1. Improved Physical Health Outcomes

Hospital mobility programs play a vital role in maintaining and enhancing patients' physical health during their hospital stay. These programs help preserve muscle mass, which is crucial for recovery and post-discharge functionality. Even a couple of days of bed rest can lead to rapid muscle atrophy, especially in the frail elderly and others already medically or physically compromised.

Movement aids in maintaining cardiovascular function, reducing the risk of complications such as deep vein thrombosis. Mobility can improve lung function and decrease the risk of respiratory complications, which are common in immobile patients.

Movement also helps maintain normal digestive function, reducing the risk of constipation and other gastrointestinal issues that frequently concern hospitalized patients.

2. Mental Health Benefits

The impact of mobility programs extends beyond physical health, significantly affecting patients' mental well-being. These programs can combat feelings of helplessness and depression that often accompany prolonged hospital stays, providing a sense of agency and progress.

For older patients or those at risk of delirium, maintaining mobility can help preserve cognitive function and reduce the risk of hospital-acquired delirium, keeping their minds active and engaged. Regular movement during the day can also lead to better sleep at night, which is crucial for healing and overall well-being.

Perhaps most importantly, mobility programs can provide a sense of routine and normalcy in the otherwise disruptive hospital environment, helping patients maintain a connection to their usual daily activities and fostering a more positive outlook on their recovery process.

3. Long-term Healthcare Utilization

While mobility programs may not directly impact hospital reimbursement, they can significantly affect avoidable and often compounding long-term healthcare utilization.

Additionally, mobile patients often recover faster, potentially leading to shorter hospital stays. Shorter stays mean more open hospital beds, which can be a big incentive for hospitals often on divert because they are at maximum capacity.

4. Patient Satisfaction and Leverage

Patients who maintain their mobility often report higher satisfaction with their hospital stay, which can lead to improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. These scores are increasingly tied to reimbursement in some models, providing an indirect financial incentive for hospitals to prioritize mobility programs.

Hospitals known for their effective mobility programs can use episodic outcomes data to demonstrate their value to payers, who are always looking for effective ways to reduce total cost of care to the populations they insure if it doesn’t reduce quality of care.

This can be helpful in contract negotiations. Hospitals who can demonstrate proactively how they are more successful in reducing discharges to inpatient settings are in a better place for negotiating payer contracts. This is still mostly an unrealized opportunity.

And when organizations find themselves in new territory, such as being mandated into TEAM (as over 740 hospitals are) or being asked to join the state’s AHEAD Model and move to global budgets in multi-payer arrangements, they are more prepared to succeed with a robust mobility program already in place.

Overcoming Barriers to Implementing Hospital Mobility Programs

Despite the clear benefits, implementing comprehensive mobility programs faces several challenges:

1. Financial Constraints

As noted earlier, mobility programs are often seen as cost centers. To overcome this financial hurdle, hospitals can employ several strategies. First, conducting thorough cost-benefit analyses that include long-term outcomes and potential savings from reduced readmissions and post-acute care needs in episodic and other value-based care payment models can help justify the investment in mobility programs.

Value-based care is becoming increasingly important in healthcare reimbursement models, so it can help the hospital align with broader organizational goals.

Hospital can also explore grant opportunities for implementing and studying the effects of mobility program. This is always an additional funding source worth exploring.

2. Staffing Challenges

Implementing mobility programs often requires additional staff or increased workload for existing staff. To address staffing challenges, hospitals can adopt a multifaceted approach.

Hospitals should adopt an interdisciplinary approach to building their programs, involving many key members of the care team. One way mobility programs can be designed and implemented is by modeling evidence-based programs that have proven successful. This collaborative approach ensures that mobility is integrated into all aspects of patient care.

Generally speaking, the physical rehabilitation department and nursing department form the foundation for the program development, and nursing assistants and/or physical therapy aides can carry out this non-skilled service. The program should preserve therapists’ expertise for work that requires their specialty care, and mobility programs should limit the need for therapy secondary to hospital bedrest.

Comprehensive staff education is also crucial. Providing training to all staff members on the importance of mobility and basic mobilization techniques empowers everyone to contribute to patient mobility, regardless of their primary role.

3. Cultural Shift

Changing the culture to one of mobility requires a significant shift in mindset. Implementing a successful cultural shift towards mobility requires a multi-faceted approach.

Hospital leadership support to drive this change throughout the organization is crucial. Their endorsement and active involvement can significantly influence the adoption of new practices.

Comprehensive and ongoing education is also essential. This involves informing patients, families, and staff about the risks associated with immobility and the numerous benefits of maintaining movement during hospital stays.

The development and implementation of clear mobility protocols that are seamlessly integrated into daily care is vital. These protocols provide a structured framework for staff to follow, ensuring consistency in approach and helping to embed mobility as a core component of patient care.

The Future of Hospital Mobility Programs

As healthcare continues to evolve, the importance of hospital mobility programs is likely to grow:

1. Integration with Technology

Advancements in technology could revolutionize hospital mobility programs. The use of wearable devices, such as activity trackers, could enable healthcare providers to monitor patient movement and set personalized mobility goals, tailoring interventions to each patient's needs and progress. Virtual reality systems offer the potential to make mobility exercises more engaging and enjoyable for patients, potentially increasing compliance and motivation.

2. Policy Changes

Future healthcare policies are likely to place greater emphasis on mobility in hospital settings. This shift may manifest in several ways.

For example, we could see the inclusion of mobility measures in hospital quality metrics and reimbursement models, directly tying financial incentives to patient mobility outcomes.

Then there's potential for the implementation of mandatory programs, requiring hospitals to establish comprehensive mobility initiatives as part of their standard care protocols.

We could even new funding allocated for research into the long-term impacts of hospital mobility programs, providing a stronger evidence base for their implementation and refinement.

The benefits of these programs extend far beyond the immediate hospital stay, impacting long-term health outcomes, healthcare utilization, and overall quality of life for patients.

The challenge lies in bridging the gap between the clear benefits of mobility programs and the current reimbursement structures that don't directly incentivize them (other than for hospitals in value-based care programs that include significant financial risk). By focusing on long-term outcomes, patient satisfaction, and the potential for reduced healthcare utilization, hospitals can build a strong case for implementing and expanding these crucial programs.

Ultimately, the goal of healthcare should be to facilitate the best possible outcomes for patients. Hospital mobility programs are a key component in achieving this goal. As we move forward, it will be crucial for healthcare leaders, policymakers, and practitioners to recognize the value of these programs and work towards creating systems that support and incentivize their implementation.

You might also enjoy this article I wrote on Hospital at Home:

Additional Reading and Resources: