When the Patient-Driven Payment Model (PDPM) took effect October 1, 2019, therapists wondered if their days were numbered — or at least limited. The decoupling of therapy minutes and Medicare reimbursements seemed to suggest that therapy utilization might greatly decrease in 2020.
But the challenges of the COVID-19 pandemic have created a new urgency around therapy, and a new opportunity for therapy providers to think creatively about how to deliver care.
Therapists can use a PDPM lens to succeed during COVID-19 by triaging their services and resources the same way that health care providers are triaging personal protective equipment (PPE), and by reimagining and reallocating how they deliver care.
Here are three key ways to reimagine therapy services during COVID-19, and beyond.
Reimagine Your Staffing Allocation
When the Maryland-based Flagship Rehabilitation began preparing for PDPM, they had no way of knowing that their diligent work would reap benefits well beyond the confines of the new payment model.
But the coronavirus pandemic brought their preparation into a new light and set them on a course for fast and nimble adjustments in the future.
“We were extremely prepared for PDPM, and our clinical strategy to focus on function and outcomes became a natural transition into delivering care when COVID hit,” says Chelsea Boyle, occupational therapist and Chief Operating Officer for Flagship Rehabilitation. “We had no idea how hard COVID was going to hit, or for how long, but we were ready and flexible in making the necessary shifts.”
The first key for Flagship Rehabilitation was to reimagine how to use their staff and their spaces, and to educate their staff members about the new way of providing essential services. They immediately created a COVID Response Team, which spearheaded communication with partner communities to ensure that their efforts as the therapy provider complemented and helped propel any infection control guidance that was being put in place to keep the communities safe.
Flagship Rehabilitation identified COVID-dedicated therapy teams or staff members within each location that could be immediately mobilized if an active COVID-19 case was identified. In many communities, there was a necessary limitation on movement of staff members around the campuses to minimize transmission risk, so the therapy clinical leads and teams had to think strategically and creatively about how therapy services could continue safely and appropriately based on clinical need.
Those nimble capabilities were especially critical when COVID struck their partner communities in rural areas.
“We had to improvise,” Boyle says. “We had to make decisions and we had to make them quickly so that essential therapy services would continue to be provided to the residents. We were able to give all the necessary services to the residents and still successfully meet the expected outcomes.”
Reimagine Therapy Methodology
The challenge of delivering therapy while also navigating infection control restrictions created another need for the reimagining of services, this time in methodology. The COVID response team and the proactive education and planning again led to faster pivots and the ability to be proactive with adjustments in patient-care delivery.
“COVID-19 posed a very real challenge to our therapy team to continue to provide essential therapy services while also managing and balancing infection control risk within the communities that we are in,” says Irene Henrich, Director of Quality and Compliance at Flagship. “We were able to reimagine, coach and train our teams to provide therapy in a different way when it was necessary.”
Flagship Rehabilitation instituted the use of virtual therapy services with the resident and therapist being in the same institutional setting, calling the program Telecommunications Technology Therapy Services, 3TS, in order to continue to optimize staffing models, minimize exposure risk within the campuses and still provide essential care. Flagship also then swiftly moved into providing telehealth services when Medicare finally allowed therapists to bill for telehealth visits.
“As a therapy provider, we were able to successfully identify, create, educate and train our therapy teams to deliver essential therapy services in new, reimagined ways that would not have been explored until a year or two or three from now based on the regulations afforded to us,” Henrich says.
They’ve seen results: Despite the limitations and modifications in care delivery under COVID-19, Flagship’s Section GG mobility scores have increased by 2.33% during the period covering the COVID-19 pandemic.
“We think that speaks to the fact that while we had to shift into these new methodologies, we never lost sight of the goal of quality outcomes and resident-centered care,” she says.
Reimagine Therapy Utilization
With PDPM, Flagship Rehabilitation was already making shifts as to how they would effectively utilize their therapy services to propel the quality goals of their partner communities. That period from October, when the new payment model took effect, into the end of February — a soft opening, as they see it now (in light of COVID hitting in March) — gave them enough time to reimagine therapy utilization so that when COVID-19 hit, they were able to pivot quickly.
What they’ve learned is that COVID-19 has made therapy even more essential, not less, and that therapists can continue to impact quality outcome measures if they know how to deliver their services in the most quality-centered and resident-driven way.
“COVID-19 has proven thus far that therapy is essential in preventing and slowing down functional decline due to isolation, that therapy is the golden standard for improving functional outcomes, and that therapy services are an essential part of treating the whole patient to get them transitioned to the next level in the post-acute care continuum,” Henrich says.
“COVID has really hit our communities financially, and I think that as their therapy partner, we have been able to have been able to allocate our resources and services to help alleviate some of this burden” Boyle says. “When COVID hit, we were able to make those internal decisions that we felt were best aligned with our partners so that they could focus on the bigger picture of keeping their communities safe.”
That bigger picture was as simple as it was essential: keeping residents safe, keeping staff safe, continuing to provide the necessary services and all while navigating the daily updates from CDC, CMS and a given state’s department of health.
“That way, our partner communities didn’t have to worry about how they were going to continue to provide care and ensure residents would continue getting essential therapy services despite the isolation and restrictions,” Boyle says.
In the end, preparing for PDPM gave Flagship Rehabilitation the skills needed to adjust to COVID-19.
“The lessons we learned in this critical time will continue to be strategically employed to focus our continued efforts and services on the residents’ clinical profile and quality outcomes,” Henrich says.
To learn more about how Flagship Rehabilitation can help you deliver therapy under PDPM during trying times, whether COVID-19 or beyond, visit FlagshipRehab.com.