The new Resident Classification System, which may be implemented Oct 1, 2018, is changing the game. I say “may be implemented” because there’s reason to believe that it may be delayed a year. But either way, it will happen and it will change the way we are paid and how we deliver services.

When a reimbursement change happens, we change our systems. Does that make sense for the patient? No, it rarely does. But when you enter into our world, when you get into our industry for the right reasons, you will deliver the best care under the imposed circumstances.

A quick refresher: Right now under PPS, Therapy is the heaviest revenue-producer. The amount of therapy delivered, along with the ADL scores, determines payment. According to the Advanced Notice of Proposed Rulemaking (ANPRM), SNF PPS will be replaced by RCS-1. There will be four major categories:


  • Physical Therapy/Occupational Therapy
  • Speech Therapy
  • Nursing
  • Non-Therapy Ancillaries (NTA)

The PT/OT and ST categories will no longer be based on days and minutes, but rather on Resident Characteristics. Most of the assessments and ARDs will be eliminated, and the 5-Day assessment will determine payment for the ENTIRE stay (unless there’s a significant change.) No more 14-Day, 30-Day etc. assessments. No more COTs. No more EOTs. No more SOTs. Remember the ADL scores Mnemonic Device BETT (Bed mobility, Eating, Toileting, Transferring)? Now it will only be ETT, bed mobility will be eliminated.

Essentially, payment will be based this way:

PT/OT base rate x PT/OT CMI

+ ST base rate x CMI

+ Nursing base rate x CMI

+ NTA base rate x CMI

+ Non-case mix base rate

Confused yet? Me too. But as we all know, it takes practical application of any new system before you’re comfortable with it and understand how it flows. We will make mistakes, we won’t make them twice.

Every therapist I talk to is concerned about their jobs. If therapy isn’t the driver, how can our profession survive?

As therapists, we will always be a valuable component of geriatric care. The means of getting paid will be different, but the care we deliver should not change. My motto has always been “If you do the right thing for your patients, the money will follow.” Our delivery of care should not change dependent on the business aspect of our industry. Every October we have to adapt to something new, and we are nothing if not adaptable. Some of our SNFs and rehab agencies will panic and begin the layoffs (see 1998 and the subsequent re-hiring when PPS turned out less apocalyptic than imagined), but some will soldier through and continue to provide the best care they can. We need to rely on our knowledge of the Big Picture and not let insurance dictate our practice, for the good of our populations.