Speech Therapy Poised to Take Center Stage in Skilled Nursing Under PDPM

Among the potential upsides and pitfalls under the new Medicare payment system for skilled nursing facilities, one specialty comes up consistently as an area of great opportunity: speech therapy.

When the new Patient-Driven Payment Model (PDPM) takes effect next October, speech therapy will play a greater role in a resident’s overall care plan than under the current Resource Utilization Group (RUG) system, several third-party therapy providers told Skilled Nursing News. Even as operators no longer have a financial incentive to log as many therapy hours as possible, speech services — along with physical and occupational therapy — will have a direct impact on how skilled nursing providers can prove solid outcomes and maximize their total reimbursements.

“Moving from the RUG system, it gives us our own unique identity,” Michael Webb, co-founder and CEO of the New York State-based therapy provider Language Fundamentals, told SNN. “We’re not mixed into the aggregate of PT and OT. Now, having our own identity with PDPM, really is a big game-changer.”


The Centers for Medicare & Medicaid Services (CMS) designed PDPM to more closely link reimbursements to skilled nursing facilities with the complexity of the care they provide. While the exact repercussions of the new system remain to be seen in the real world, experts have emphasized the importance of accurately recording each resident’s specific health needs and then tailoring their care plan to those issues.

Not only will the strategy potentially result in more personalized care for residents, but many industry players have suggested that SNFs could see greater reimbursements, as the new system will specifically reward them for providing certain nursing services that did not affect Medicare dollars in the past.

Speech isn’t just talking


Speech therapy includes more than just communication, such as the treatment of swallowing disorders and patients who require mechanically altered diets. Identifying those needs and meeting them with appropriate therapy will determine a SNF’s eventual reimbursement dollars, and if a speech therapist isn’t involved in the initial assessment and collection of the Minimum Data Set (MDS) information, the financial implications could be significant: Garry Pezzano, senior vice president of clinical practice at Genesis Rehab Services, said the daily rate for a speech-language pathology could vary from $16 to more than $100 depending on the accurate identification of swallowing and altered diet needs.

“For speech specifically, PDPM has really increased that need to be really strong advocates, to demonstrate the value of the impact that we have on patient care and restoring patient function,” Josh Pickus, CEO of Optima Healthcare Solutions, said. “And that’s directly for the patients themselves, but also indirectly — through interdisciplinary team involvement and helping with the processes all around for patient care in the skilled nursing facilities.”

There’s another reason why speech will play an outsized role in Medicare reimbursements going forward. Under PDPM, reimbursements for physical and occupational therapy services will begin to decline after a resident’s 20th day in the skilled nursing facility — but not for speech.

“CMS has determined that they believe the need decreases, and so there should be a lower payment,” Pickus said. “They have not done that with speech. With speech, you get a consistent rate throughout the period, and so at some level, speech is even more attractive.”

Teamwork matters

At Genesis Rehab Services — the rehab arm of the Kennett Square, Pa.-based skilled nursing giant Genesis Healthcare (NYSE: GEN) — Pezzano is preparing for PDPM by emphasizing the importance of speech and other therapy services to the company’s clients. That push will require deeper integration with the existing professional teams at SNFs, as PDPM shifts the focus toward caring for the patient’s whole needs.

“There’s no way that silos can exist with PDPM,” Jordan Bowman, a regional clinical director at Genesis, said. “Hopefully, they weren’t existing before.”

The idea of collaboration and teamwork has come up frequently in discussions about PDPM, but Pezzano and Bowman emphasized that breaking down the barriers between nursing, therapy, and other services at nursing homes will be vital for success under Medicare Advantage, accountable care organizations (ACOs), and other new payment models that place a heavy emphasis on improving quality and slashing hospital visits.

“We know that patients return to the hospitals largely because there’s a medication error. There’s an infection. There’s a fall,” Pezzano said. “And if we are able to identify those patients who are at risk for those types of incidents, we could really get ahead of the game, and we could support the rest of the professional team, the patient, and their family in mitigating those.”

Webb has already seen a change in Language Fundamentals’ clients, which include more than 80 skilled nursing facilities across New York. Whereas in the past, SNFs had waited to bring in speech therapists to perform an initial assessment, more and more want therapists to see their residents as soon as possible to identify potential co-morbidities and ensure accurate data collection, Webb said.

“Our communication is going to be key,” he said. “We need to make sure that we are strongly dialoguing with the appropriate people to make sure that all of that is on the initial MDS.”

Written by Alex Spanko

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