The Health Dimensions Group PDPM team has spent countless hours digging through data, researching best practices, utilizing a think tank approach, and working with managed communities and other clients to consider the future of therapy under the Patient-Driven Payment Model, which will be implemented on October 1, 2019.
Our belief regarding therapy moving forward is this: We will make it through like we have in the past with previous payment model changes. This is a huge change, but we have had significant changes in the past.
We believe there definitely will be an evolution in therapy practice—it happened under the RUGs system. With the prospective payment system (PPS), providers were incentivized to adapt to the payment structure. We learned to balance our missions and care community goals while focusing on patient satisfaction, as well as maintaining good business sense.
Earlier this decade the industry saw a significant increase—almost 30 percent—in therapy utilization in the Ultra-High Rehabilitation (RU) category. This change in practice came with program development, staff training on best practices, and a focus on allowing patients as much therapy as possible. The conditions of patients seen in the past 10–15 years have become more acute and more complex. The industry answered that by focusing attention and reimbursement on the therapy area.
We currently deliver services under Medicare Advantage/managed care plans with less intensity and have shown good outcomes with these patients. The bottom line is that this process works. Patients are going home safely and are not being rehospitalized, while therapists are working differently than they do with traditional Medicare.
Therapy services will evolve due to the PDPM’s change to a greater focus on patients’ clinical needs in partnership with:
We believe it is unreasonable to expect there will be no change to therapy under PDPM.
All of this evolution must be directly tied to clinically appropriate interventions and the resulting outcomes from all therapy treatment. The incentives and focus will change with PDPM and, therefore, the industry will alter its direction to deliver services most efficiently. Team collaboration, use of a 72-hour post-admission meeting, education, and an emphasis on efficiency while being hypervigilant on outcomes will need to be the focus starting now.
Therapy services will continue to be an important part of the overall interdisciplinary team, but a focus on the bigger picture of a patient’s needs will take the forefront. This will be the driving force to determine the best care for every patient.
Please contact us if you would like to learn more about how HDG can assist your organization in preparing for this important change in payment. For more information, visit our website or contact us at 763.537.5700 or firstname.lastname@example.org.
Authored by: Michelle Kastenholz, OTR,
Director of Reimbursement and Therapy Services