Despite The Centers for Medicare & Medicaid Services’ assertion that the new Patient-Driven Payment Model “focuses on the unique, individualized needs, characteristics, and goals of each patient,” there is ongoing confusion within the industry about what PDPM is, and what it is not.
Contrary to some misconceptions, the value of the licensed practitioner is more important now than ever under the new payment model. While rehabilitative therapies are no longer the driver for Medicare payments, they remain a necessary and vital component in recovery and daily maintenance for many nursing facility patients and residents.
While some providers may think the introduction of PDPM creates an opportunity to fundamentally change how therapy services are provided, that is not the case. Medicare’s skilled care criterion remains unchanged. As a refresher, the federal agency’s definition is:
“A type of healthcare given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Nursing, physical therapy, occupational therapy, and speech therapy are considered skilled care by Medicare…”
This definition maintains the ongoing role of rehabilitative therapies in SNF care.
What has changed under PDPM is a move toward value-based care and away from volume-based care. This means that there is an increased reimbursement value for nursing services based on patient characteristics, but the new system also takes into account each patient’s individual diagnosis, co-morbidities and level of functional impairment.
Despite the fact that therapies will not be a driver of reimbursement levels, as they were under the Resource Utilization Group model, they will still be essential to drive quality care and patient outcomes. In fact, therapies have been shown to have a huge impact on reducing lengths of stay and readmission rates, and improving functional outcomes and quality of life.
Speaking of hospital readmissions, one study concluded that “physical therapists can contribute meaningfully to existing care transition models and work collaboratively with other health care disciplines in reducing avoidable hospital readmissions.” This underscores the value of therapists in assisting providers with managing their readmissions within the context of the value-based purchasing program.
CMS has made it abundantly clear that it will be closely observing SNF practices under PDPM and is monitoring clinical outcomes for patients under the new payment structure. The expectation is that SNFs will use this opportunity to innovate practices; however, providers must be mindful that CMS expects the same, or better, outcomes for patients under this new payment model.
In order to meet this standard, multiple therapy disciplines should be represented on the interdisciplinary teams that develop and execute every patient-centered care plan. Providers cannot be short-sighted when determining the value of their therapy resources. For some facilities, this may require partnering with a contract rehabilitation partner, particularly one well-versed in ICD-10 coding.
In order to succeed in this new model, SNFs need therapy partners who understand the ins and outs of PDPM, and the risks that changing therapy services for patients may have in terms of additional future policy or reimbursement changes. A contract partner, like RehabCare, can provide the strategic guidance and collaborative approach to help providers achieve the most efficient operations under PDPM and achieve the best possible outcomes for patients.
In RehabCare’s 20-plus year history, it has always focused on outcome-driven data versus the volume of services, putting patients at the center and delivering high-quality clinical outcomes. Nothing changes this focus under PDPM.