Only 32% of Skilled Nursing Providers Feel Clinically Ready for PDPM

As they get ready for the Medicare Part A reimbursement system taking effect October 1, skilled nursing providers have a high degree of confidence in the preparedness of their interdisciplinary teams.

But that confidence plummets when assessing the preparedness of their clinical teams, according to a new survey from the Plano, Texas-based Reliant Rehabilitation.

The survey, which drew from 70 respondents representing more than 130 SNF communities, found that operators are prioritizing therapy treatment processes and initial evaluations as they get ready for the Patient-Driven Payment Model (PDPM). Specifically, therapy treatment pathways were ranked as the top PDPM concern by 48% of respondents; the initial evaluation process was selected as the top PDPM issue by 44%.


“I think it speaks to one of the common questions we’ve really heard over the past several months … and that is: What happens to therapy under PDPM?” Reliant chief strategy officer David Tate told Skilled Nursing News. “From the beginning, we’ve felt that in the absence of therapy minute thresholds, we need to provide our therapists with the clinical guideposts that help them understand how to provide the right level of care for each patient, as defined by PDPM characteristics.”

Still, the results showed a sharp divide between providers’ feelings on overall PDPM readiness: While 69% of respondents said they were confident in their interdisciplinary teams’ preparedness for the new payment model, only 32% said their clinical teams were up to the task.

“This response is consistent with the fact that interdisciplinary teams have been integral to health care for many years, while PDPM is new and not yet well understood,” Tate said in emailed comments to SNN.


The surveyed group included both providers that perform therapy services in house and those that outsource therapy, with 64% of respondents employing third-party providers, 24% using an in-house model, and 12% reporting “other.”

Reliant is preparing to provide its therapists with clinical pathways for specific conditions, a method for ensuring the proper type and frequency of interventions in the absence of therapy hours as a key driver of reimbursement. Understanding how to provide the right level of care under PDPM requires a more thorough interdisciplinary process, and while that exists somewhat at present, Tate believes it was stronger prior to the prospective payment system.

The evaluation process cropped up in more ways than one on the survey. When asked what attributes were the most important when considering a therapy partner, 90% of respondents said a highly skilled evaluation team was an asset of “somewhat” or “much more” interest.

“I think as we have reviewed this process under PDPM, our therapists are excited about an additional emphasis on the value of that evaluation, and how the evaluation will help determine the clinical categories and ultimately the levels of care received by the patients,” Tate told SNN.

Clinical protocols and pathways, as well as support for evaluating non-therapy components, came in second at 75% each.

To help therapists get ready and have the “guideposts” that they’ll need, Reliant gathered a consortium of therapists and a group of clinicians working in the post-acute space to have them profile patients’ case-mix categories under the current system, what type of care they need to receive, and how often they have to receive it. Each group performed this task separately, then synthesized the results together to form conclusions.

“The guideposts today are largely defined by Medicare [Resource Utilization Groups],” Tate said. “And without those thresholds, we wanted to provide those.”

Reliant is now in the process of training and teaching therapists generally about the evaluation process and how it ties into PDPM characteristics, as well as how to use care management guidelines, he noted.

One survey finding that stood out to Tate was the fact that just 10% of respondents cited risk mitigation as a top PDPM issue; it’s a topic that has come up frequently in conversations with current and potential clients, he explained. Still, he believes this is more due to the context of the survey, rather than risk mitigation not being important to SNFs.

Overall, the prominence of therapy treatment pathways and the initial evaluation process matched what Reliant has been seeing in terms of PDPM preparation, Tate said.

“We believe that these are things that are part of the value proposition of therapy under PDPM,” he told SNN. “When those two came on top, it affirmed what we believed and what we’ve been preparing to do, which is provide these clinical pathways or guideposts.”

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