Providers Can’t Fall for Therapy Myths When Preparing for PDPM

As skilled nursing facilities and rehabilitation providers across the U.S. prepare for the changes to Medicare payments coming in October, they have to make sure they don’t get sidetracked by a slew of misconceptions about what’s coming.

That’s according to a Tuesday webinar by clinical management software provider Optima Healthcare Solutions, held in conjunction with Skilled Nursing News.

The panelists, who represented a range of therapy and rehab providers with a presence in hundreds of SNFs across the country, dismantled several myths about the Patient-Driven Payment Model (PDPM) and the role that therapists will play under the new system.


Don’t expect mass therapy reductions

Under the new model, reimbursements will driven by the characteristics of the patient rather than the amount of rehabilitation minutes provided, as is the case under the current Resource Utilization Group, Version IV (RUG-IV) structure. The very first myth, therefore, is the prediction that SNFs will see a mass reduction in therapy provision once PDPM takes effect October 1.

That isn’t going to be the case, according to Jonalyn Brown, vice president of operations at consulting and therapy company Consonus Healthcare — which is owned by Milwaukie, Ore.-based Marquis Companies. But it’s understandable why the question comes up, she noted.

“This is often the elephant in the room … The question is: What happens to therapy?” Brown said on the webinar.


There are some key factors that make the mass reduction a myth, Brown explained. While there will be a shift in services, particularly since therapy teams won’t be pressured to make up minutes if a patient has to miss an appointment, the amount will not decline in the move from RUG to PDPM — but only if therapy has been historically provided based on patient needs.

The Centers for Medicare & Medicaid Services (CMS) has also been clear that officials will be monitoring the amount of therapy listed on patients’ discharge assessments both before and after the shift, Brown noted.

“They threw that out as a statement that they do not expect therapy to drop,” she said.

Survival is not contingent upon in-house therapy

Another major PDPM myth related to therapy is that the only way to survive is for SNFs to take therapy in-house. Some cast it as a cost center after the finalization of PDPM, as opposed to its current role as a reimbursement generator. But the decision of whether or not to go in-house is a complicated one, Hilary Forman, chief clinical strategies officer at HealthPRO/Heritage said on the webinar.

HealthPRO provides third-party rehab and consulting services and rehab management to a variety of post-acute providers.

Skilled nursing operators must contemplate the complexity of managing therapy volumes, and how those levels will change from RUG-IV to PDPM; the need to train and educate staff leading up to and after the move to PDPM; and the creation of clinical pathways, Forman noted.

To make the decision to go in-house cost-efficient, a SNF provider would have to be “pretty heavily resourced,” she said. And in an era of razor-thin operating margins, that’s not always a given for SNFs.

“I don’t think the only way to survive is to go in-house, but do make educated decisions based on the specific needs of your company or facility,” Forman said.

Providers will also have to be wary of looking at group and concurrent therapy as the only way to lower costs: Both therapy formats have to be clinically appropriate for the patient receiving them, Forman emphasized.

In addition to a shift toward group and concurrent therapy sessions, providers can also consider flexible therapist scheduling, redesigning electronic medical records, streamlining documentation, and entering into risk-sharing contracts for outsourced therapy, Forman said.

What stays the same

One point all the panelists emphasized at different points was that patients in skilled nursing will not be changing under the new model. The requirements for Medicare-reimbursed skilled nursing care haven’t changed, and the rehab and therapy needs of a patient aren’t going to shift dramatically from September 30 to October 1.

In addition, several initiatives aimed at tracking and improving SNF quality are still in place. The Quality Reporting Program (QRP) and the Value-Based Purchasing (VBP) program are still in effect, keeping tabs on what SNFs bill, their readmission rates, and other measures — and those programs are growing. That means means SNFs have to keep paying attention to outcomes under PDPM, according to Ellen Strunk of Rehab Resources & Consulting.

“Even though there’s not necessarily an outcome benchmark built into the PDPM measure itself, I think it’s important that SNFs realize they are being measured on their outcomes already in a number of ways,” she said.

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