It has paid to have a thick skin or optimistic nature lately if one is a post-acute therapy provider. Luckily for Martha Schram, she has both.

Schram and fellow therapy executives started the Patient Driven Payment Model era Oct. 1 by dodging arrows from disgruntled therapists who had either lost work or knew someone who had.

Now, however, everyone is in the same wait-and-see boat as early results of the PDPM era are gathered and closely studied. It’s still not time to make any concrete judgments, but Schram already knew what it would take to declare success several weeks ago.

That was when emotions were at their hottest, shortly after numerous therapy departments and divisions had started to “right size” under new payment policies. No two therapy outfits reacted exactly the same. While we at McKnight’s heard numerous tales of therapists, young and old, unexpectedly losing work, Schram said that wasn’t the case for everyone, including her Aegis Therapies company.

“The short answer is, no, we have not had significant layoffs,” the Aegis president and CEO told me at the American Health Care Association annual meeting two weeks into PDPM. Aegis has managed by reducing PRN hours, tightening contractor work and not filling some empty positions.

They key, Schram emphasized, was devising a plan early, openly explaining it to employees and then keeping lines of communication open.

“Nothing ever substitutes for no surprises, and communicating,” Schram said. “There were several communications to our team where I said, ‘Here’s what I know, and there’s a lot I don’t know. But based on what we’ve looked at, this is what you can expect today. When that changes, I’ll let you know.”

Aegis employees were informed through the written word, messages from managers and more.

“I do a lot of town halls with staff. They just want to be kept in the loop,” Schram explained. “Surprises are hard.”

Everybody is in learning mode — execs, front line therapists, advocates and even federal regulators themselves. Schram said it should be relatively easy to track patient outcomes, and that they far and away will be the most powerful indicator of whether a provider is doing the right things. From there, it will be back to benchmarking and tweaking based on whether original assumptions were correct. A quarter’s worth of results, or roughly by the end of 2019, stakeholders should see enough pertinent data to act.

“Whether you’re an individual therapist, SNF provider or whatever your intersection is in our space, you have to be part of the solution or you won’t be relevant. You just won’t,” Schram said.

The key is to keep striving for better.

“The system appears to be designed to encourage everybody to think in new and different ways,” Schram observed. She calls it a system that “actually supports that, which is different from a system that [merely] allows that. At the end of the day, this has such high potential for being better for the patients we serve.”

Patience is still a virtue Schram asks for. That and quality care.

“To be relevant, you have to make adjustments,” she emphasized. “And never lose sight that you cannot compromise on patient care.”

Follow Executive Editor James M. Berklan @JimBerklan.