James M. Berklan

I was dutifully taking notes last week at one of the more fascinating educational sessions I had attended in recent years, and then it hit me: What once was the reigning rave about the Patient-Driven Payment System had all but vanished from many radar screens.

I knew because I, too, had once been obsessed over “What’s going to happen to the therapists?” But in all the focus on new educational campaigns — be they about clinical complexities, non-therapy ancillaries, IPAs, MDS, ICD-10 or other topics — I had all but forgotten to give extra attention to the contract therapists who had driven the Medicare reimbursement climate and RUGs system for so long.

This session’s speakers cut to the chase, however: Would we see SNFs go away from contract therapy under PDPM?

No. Or at least not right away, was the answer.

Panelists were unanimous in their “keep the tiller steady” advice. In brief, if you’re contracting now, stick with it. If you’re fielding your own therapy team, stick with it.

“Most will continue with what they have — as long as they can renegotiate” rates if they’re contracted out, said CareTrust REIT COO Dave Sedgwick, a licensed nursing home administrator in another life.

Contract therapy will remain appealing to its proponents for the same reason they chose it in the first place, he explained: “They contracted to share risk.” They’ll make a decision whether to stay the course or switch strategies in due time, he predicted.

“In about six months, we’ll see a move one way or another,” agreed Dava Ashley, president of California-based Covenant Care.

Wait six months, agreed American Health Care Association President and CEO Mark Parkinson. Make no long-range commitments.

The occasion was the annual fall meeting of the National Investment Center for the Seniors Housing and Care Industry. Parkinson will host his own show in almost four weeks (or PDPM +12 days, as we say in the biz).

You can be sure the PDPM blast-off will still be garnering plenty of attention.

Federal officials will be scrutinizing therapy usage patterns, something providers better be aware of on their own, Parkinson cautioned.

A limit of 25% of therapy can be group or concurrent activities under PDPM, a ceiling providers are expected to bump their heads on after all but ignoring the stuff under the current RUG-IV system. This, despite the fact that a top Centers for Medicare & Medicaid Services regulator in spring warned that therapy usage patterns should not change much under PDPM.

“Obviously, CMS sees a value in group and concurrent therapy,” Parkinson spun last week, however. “It would be surprising if they were surprised.”

Parkinson added, however, that the profession would get “quite a negative reaction” if the overall number of minutes performed dropped significantly. “If there’s a drop in overall minutes of 15 to 20 percent, we’ll have our hands full,” he predicted.

That’s one consideration that providers better make sure stays on their radar screens come Oct. 1 and well beyond.

Follow Executive Editor James M. Berklan @JimBerklan.