In a McKnight’s article published April 5, Editor James M. Berklan detailed a somewhat contentious meeting during the AANAC / AADNS conference in Florida, in which the value of continuing therapy was discussed with respect to the new PDPM payment system. Berklan wrote many were concerned about “bad actors” who limit therapy resources in favor of increased payment.
Thirteen hundred MDS nurses and DONs in attendance were discussing how to maximize and adapt to our new edict that goes into effect in this October, and the value of therapy was disputed.
Hopefully, the education that was given at that time was effective. But comprehensively throughout the nation, this is an issue that will continue to be discussed and continue to be debated.
We are in healthcare. This means that our jobs are to care for the health of those we are pledged to foster and restore. Over my many decades of working, first as a treating physical therapist, then a manager, and eventually as a Director of Operations, it has become my mission to ensure that those I work with understand this nearly-sacred trust. So few in our population are lucky enough, respected enough, and trusted enough to do this job. We are REQUIRED to understand the needs of our patients. We are REQUIRED to attend to the needs of the sick and elderly whose families have entrusted us with their care.
We also are required to get paid.
In this New World Order of PDPM (note this is the acronym for Patient Driven Payment Model, which eponymously means that the PATIENT CARE drives the payment), therapy will be important, not just for payment but for the care of the patient. How many of us are willing to admit our loved one to a skilled nursing facility for rehab where therapy has been cut 30% because an administrator’s knee-jerk reaction resulted in fewer therapists employed and fewer minutes delivered? How’s your dad’s stroke rehab going to go? Will he regain his function? The facility will get paid, but they may cut therapy time because therapy isn’t driving the payment bus anymore. This is shades of 1998 when PPS was new and therapists were laid off for the first time — ever. They were then re-hired when the SNF-pocalypse didn’t happen.
Speaking of minutes: I have been asked about 365 times (about once a day for the past year) how we are going to deliver minutes in the PDPM world. My answer is always the same: Do what you need to do to make the patient better. Is the patient going to get better with 23 minutes of PT today? Deliver 23 minutes. Does he need 123 minutes tomorrow? Deliver 123 minutes.
PDPM will not box us into the crazy and illogical categories we have been dealing with for two decades. We will be able to deliver the care we need to deliver that the patient needs that day. And it may not be illogically uniform every day.
Of course, PDPM will pay for therapy, as PT/OT and ST will have their own inputs to the case mix by which we’ll be paid. The difference is that therapy is no longer the SOLE driver of payment. But they’re still drivers.
Rationing care will not benefit the patient. Rationing care may benefit the facility’s bottom line in the short term, but will not generate positive outcomes and good will in the community. As I advise and sometimes lecture, we need to do the right thing for our patients and our customers. The money will follow.
Jean Wendland Porter, PT, CCI, WCC, CKTP, CDP, TWD is the Regional Director of Therapy Operations at Diversified Health Partners in Ohio.