One key provider advocate is expressing optimism that a pending new payment system will spare operators from therapy upcoding lawsuits like the one settled for $10 million Wednesday.
Implementation of the Patient-Driven Payment Model will reward value of services provided, rather than volume of services, pointed out Cynthia Morton, executive vice president of the National Association for the Support of Long Term Care.
“While moving to a new payment system is fraught with problems, we look forward to a model that is not based on volume and that measures patient outcomes, because that is what really matters,” Morton said.
The new system is targeted to be in place by Oct. 1, 2019.
“While it is not tied directly to outcomes, we do have outcome measures on the very near-term horizon that will help measure our patients’ functional change, which is largely driven by the rehab therapy provided to the patient,” Morton noted.
Wednesday’s settlement involved Southern SNF Management Inc., Dynamic Rehab and nine affiliated SNFs in Florida and Alabama.
The case covers October 2009 through December 2013, when the accused allegedly encouraged the delivery of “medically unreasonable and unnecessary therapy without regard for patients’ individual clinical needs.”
Three whistleblowers, former employees of one of the facilities, initiated the case and will receive $2 million of the recovery funds, DOJ officials said.
John Matson, a spokesman for the Alabama Nursing Home Association, encouraged providers to use consultants or vendors who have been properly vetted by a third party, as his group does.
“We certainly don’t condone this type of behavior,” Matson told McKnight’s. “Hearing reports like this is disheartening because we know the good rehabilitation work that takes place in our members’ facilities.”
