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And the Winner Is... Update from CMS Regarding PDPM

Late Friday afternoon, April 19, CMS released the FY 2020 SNF PPS Proposed Rule, specifying a few changes for the Patient-Driven Payment Model (PDPM). HealthPRO® Heritage is looking forward to reporting out on all the modifications, but can’t wait to share the following good news…

According to last night’s announcement – CMS states that in the unpublished rule, Group Therapy will be defined as: “The treatment of two to six residents….” 

Up until today, CMS defined Group Therapy as: “The treatment of four residents…"

This is good news for SNF providers, therapy providers, and residents alike!

HealthPRO® Heritage suggests:  This new rule under PDPM offers us opportunity to work smarter, not harder. Incorporating a mode of therapy that allows us to work 2x - 6x as efficiently and will ultimately improve workflows, documentation practices, and bolster clinical initiatives (e.g., complimentary nursing programs like wound care).

Group Therapy has been passé for many years -- simply because of the challenges of managing it effectively given burdensome RUG thresholds and COT lookbacks every 7 days. Be absolutely certain Group Therapy did NOT fall out of favor over the concern of how beneficial it is for patients. On the contrary, Group Therapy is extremely valuable! Research conducted as recent as 2015 (Hammond, et al) and 2017 (Marumoto, et al) support that clinicians and patients see improved outcomes with appropriate use of supplemental Group Therapy. The upside for patients include: improved activity tolerance, cognitive stimulation, and accountability for self-care/disease management. Likewise, the socialization, modeling, and participating in varied group activities has been proven to boost physical activity.

There is strength in numbers with Group Therapy! CMS’ flexibility RE: this change should empower therapy to leverage important advantages and drive quality and performance outcomes. Stay tuned for more comments RE: Proposed Rule from HealthPRO® Heritage! In the meantime: As it relates to Group and Concurrent Therapy, HealthPRO® Heritage offers strategy & specifics here.  

Contact us with your questions. Reach out to us for perspective: info@healthpro-heritage.com

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Tags: Payment Reform, Patient-Driven Payment Model, PDPM, CMS Update 2019