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Nine (Really Important) Reasons Why Therapy Still Matters in PDPM

Imagine a world where reimbursement isn’t based on managing treatment minutes. Instead, therapists are empowered with the freedom to care for residents and drive outcomes based exclusively on clinical need. Let’s face it: Therapy services and reimbursement under PPS has not always served our industry well.

HealthPRO® Heritage experts agree: CMS’ PDPM system will breathe new life into how, when, and why therapists deliver care. We are, in fact, excited for a new world where our success will be measured by the evidence-based therapy we provide and the outcomes we achieve on behalf of our clients and patients.

Contrary to industry pessimists, therapy will continue to be just as integral a player in driving and protecting revenue as ever before… but in a very different way. While the misconception stems from the fact that minutes won’t be driving reimbursement, visionaries see therapy services as an important cog in the wheel that drives resident satisfaction, functional/performance outcomes, and ultimately fiscal stability.

Read on for several compelling reasons why therapy services will continue to be a priority and must serve as an “anchor” for a holistic approach with PDPM.   

#1 Patients & Families First
Post-acute patients and their families still want and need world-class therapy services. The expertise of physical, occupational, and speech therapists will always be sought after, because therapy is – undeniably – a necessary component of achieving the best possible patient outcomes.

#2 Team Work Makes the Dream Work
Irrespective of which reimbursement system (PPS vs PDPM), the SNF QRP will continue to measure SNFs based on factors that require a powerful interdisciplinary team approach. Therapy intervention and therapy outcomes must support “discharge to community” for short-stay residents, for example.  

#3 Revenue Protection
SNFs are at risk for 2% loss on all Medicare A revenue as per the SNF VBP. Without important therapy interventions (such as Safe Transitions programming, health literacy support, provision of cross continuum care, medication reconciliation support) re-hospitalization rates are in jeopardy. 

#4 We’re There For You: Support for Our Nursing Colleagues
With the transition to PDPM, one irrefutable tenet will hold true: therapy and nursing are two complimentary pieces of a puzzle that must work collaboratively to coordinate care.  

#5 Great Expectations! Partnership & Network Alliances
ACOs/BPCI A and preferred provider networks will still measure SNFs based on critical success drivers that are – in large part – driven by exceptional therapy services. Specifically, consider that SNFs are expected to transition residents to the next lower level of care in a timely manner, while also maximizing functional gains and ensuring optimal patient safety. Most often, therapists are responsible for spearheading programs, driving IDT initiatives and communicating directly with conveners to drive LOS goals and maximizing patient outcomes.   

#6 Who Else Will Track, Manage & Drive Outcome Measures?
In a world where reimbursement will be determined by how patients are cared for, the ability to track and analyze outcomes will be critical. For example, HealthPRO® Heritage is accustomed to monitoring outcomes and subsequently reconciling therapy programming in order to meet/exceed LOS and functional outcome expectations. The ability to capture outcomes and refine programming as needed is an invaluable contribution to the overall success of any skilled nursing setting and is easily driven by a savvy therapy provider.

#7 Your Therapy Company: A Blackberry or Smartphone? 
To be a valuable partner in the new PDPM world, therapy companies will need to step up their game. HealthPRO® Heritage’s role will extend far beyond providing just traditional therapy services. As leaders in PDPM consulting and education, our PDPM Expert Panel has a clear vision for PDPM readiness strategies and will prepare front line staff and SNF leaders to excel at PDPM core competencies to assure a successful transition.

#8 Two Critical Words: Quality Measures!
Short and long-stay Quality Measures will continue to impact SNF’s Star Ratings, and therefore affect eligibility for bundled initiatives participation/preferred provider networks and referral/admissions volume. Therapy offers a non-pharmacological approach to resolving many short and long-stay QMs and/or fundamentally drives programs/interventions to help SNFs maintain above average measures for the majority of QMs, including percentage of short-stay residents who:

  • Improved in their ability to move around on their own
  • Were rehospitalized after a nursing home admission
  • Were successfully discharged to the community
  • Report moderate to severe pain
  • Report pressure ulcers that are new or worsened

 And percentage of long-stay residents:

  • Experiencing one or more falls with major injury
  • With a urinary tract infection
  • Report moderate to severe pain
  • High risk residents with pressure ulcers
  • Lose control of bowels or bladder
  • Ability to move independently worsened
  • Need for help with daily activities has increased

#9 Stating the Obvious: To Skill or Not to Skill
The requirements to be able to access skilled care following an acute-care stay under Medicare Part A does not change under PDPM. Rather than thinking of therapy simply as a “cost center,” remember that patients must be in need of skilled services in a SNF for care to be covered. Under PDPM, the following CMS rules will still hold true:  A resident must require skilled nursing services or skilled rehabilitation services (see §§30.2 – 30.4) on a daily basis (see §30.6); and can be provided only on an inpatient basis in a SNF (See §30.7).  Also, services delivered are reasonable and necessary and are consistent with medical needs, accepted standards of practice as well as the nature/severity of the illness or injury.

Need support getting your head in the game? HealthPRO® Heritage is also a trusted, consultative partner leading the industry in PDPM readiness. Our deliverables: strategy, education, and execution on key clinical competencies that are crucial to PDPM success.


Tags: CMS Update 2018, Patient-Driven Payment Model, PDPM