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The Patient Driven Payment Model led to a “significant reduction” in occupational and physical therapy minutes in its first few months of implementation, a new study has found. The results reinforce providers’ anecdotal observations about reductions in therapy volume nationwide, according to a top expert. 

Investigators from Oregon State University used data from 35,540 short stays between January 2019 and February 2020 from more than 120 Oregon SNFs for their analysis.

Findings showed that “SNFs responded to PDPM with a significant reduction in individual occupational therapy and physical therapy utilization,” while also slightly increasing group OT and PT use, according to the study published last week in the Journal of Post-Acute and Long-Term Care Medicine

Specifically, data showed that the number of minutes of individual occupational therapy and physical therapy per week for Medicare stays decreased by 19.3% and 19%, respectively, in the first five months of PDPM’s implementation. The number of group OT and PT minutes also increased by 1.67 and 1.77 minutes, respectively. 

PDPM significantly expanded skilled nursing providers’ ability to use group and concurrent therapy.

Researchers called for further research into the “relative effects of individual and group therapy and their impact on the quality of SNF care” in response to the reduction in overall minutes.

Outcomes unclear

PDPM went into effect Oct. 1, 2019, and was the biggest change to the nursing home reimbursement system in at least a generation — replacing the previous case-mix classification system, Resource Utilization Group – IV.

Under RUG-IV, most patients were classified into a therapy payment group, which primarily used the volume of therapy services provided to the patient as the basis for payment classification. The Centers for Medicare & Medicaid Services argued that the system created an incentive for SNF providers to furnish therapy to residents regardless of their needs. 

PDPM, instead, classifies patients into payment groups based on specific characteristics and is aimed at eliminating the incentive to improve the accuracy of SNF payments. 

Renee Kinder, executive vice president of clinical services for Broad River Rehab, cautioned against generalizing practice across all states in response to the findings. She added that in general  the nation is seeing a reduction in therapy volume.

“We have some providers who have remained consistent in volume, others who have made minor adjustments, and some who have dramatically cut services to an unfortunately minimal level,” she told McKnight’s Long-Term Care News on Thursday. 

She said that to determine if the drop is impacting resident outcomes, providers will have to “look at how our outcomes are defined and are they granular enough to identify shifts in volume tied to shifts in function.

“Our current self-care and mobility scales, while I appreciate the standardization across the [post-acute care] spectrum, are notability limited when it comes to the unique skill of a physical and/or occupational therapist,” she said. 

Kinder also agreed with the need for more evidence-based practices regarding the optimum frequency, intensity or duration of therapy, especially with figures that account for the impact of COVID-19. 

“If we look at standards of evidence-based practice and what we now know to be true about COVID-19, many of our patients warrant a greater level of skilled care in areas of skilled rehab and skilled maintenance,” Kinder said.