Therapist groups are voicing their concerns about skilled nursing layoffs and reorganization plans in response to the new Patient-Driven Payment Model to federal authorities.
The American Physical Therapy Association, along with other physical therapist advocates, said Thursday they have been sharing stories and voicing concerns about layoffs of therapists and assistants with the Centers for Medicaid & Medicaid Services.
“PDPM changed Medicare payment methodology for SNFs on Oct. 1. It did not change the value of physical therapy services or patient needs. Reducing PT and PTA staff 48 hours into this model reflects poorly on the commitment to patient access and quality of care,” APTA President Sharon Dunn said in a tweet.
Kara Gainer, director of regulatory affairs for APTA, added the organization believes “it’s too soon to make staffing decisions that will directly result in a reduction in patient access to skilled physical rehabilitative services.”
“This new payment model is a new payment structure and it’s not a change in benefits or coverage. The value of physical therapy services has not changed, nor have the need of patients in SNFs,” Gainer told McKnight’s.
CMS did not respond to requests for comment from McKnight’s by production deadline.
Numerous therapists who work or had worked at skilled nursing facilities have been speaking out following “thousands” of layoffs amid PDPM’s deployment.
‘Small pay adjustment’
Signature Healthcare said it asked its therapy teams to “take a small pay adjustment” so it could preserve jobs following the change.
“In preparation for PDPM, Signature aimed to remain committed to our therapy programs and our therapist stakeholders. We asked our therapy teams to take a small pay adjustment so that in the end, we could preserve jobs and continue serving and providing quality care to our residents,” the company said in a statement.
“We are grateful to our therapists for being team players, accepting this necessary change, and staying with us to help us care for our residents. We are thankful for the commitment our therapy stakeholders demonstrate each and every day to our residents, and we are unwavering in our support of them and the quality services they provide,” it added.
Genesis Healthcare confirmed Wednesday that it has reorganized its therapy gyms in response to PDPM and other industry changes and laid off 585 (almost 6%) out of about 10,000 Genesis Rehab employees.
Commenters on several online McKnight’s stories have cited memos to therapy staff that discuss reduction in staff wages and mandatory group and concurrent therapy treatments. Advocates have asked people to sign a petition to support therapists.
“Companies hide behind terms to avoid disclosure. ‘We didn’t lay anyone off’ = ‘We converted most of our full time staff to PRN and aren’t guaranteeing them benefits, but no we didn’t ‘lay anyone off.’ CMS said this was supposed to be revenue neutral so NO cuts should have happened at all,” one McKnight’s reader commented.
Reports of people being laid off are unfortunately “very true,” said a speech language pathologist and former executive who said she has been in the post-acute care industry for 25 years, speaking with McKnight’s on the condition of anonymity.
“They have the right to be upset because a lot of people have lost their jobs this week and in recent months,” she added.
“But this has been coming for a long time and that same group of therapists across the country have been complaining for years about the abuses of the PPS system and the RUG-based system, complaining about Ultra-High and productivity expectations,” she said. “This new system, PDPM, came because of that outcry.”
She added that the Medicare system is pushing providers to adopt a value-based care model and focusing more on reducing costs while also trying to improve outcomes and population health.
“We have to figure out how to deliver care in the most cost-effective way as possible,” she said. “PDPM is really paying less for the component so the SNFs are paying less to the therapy companies, so if they don’t do anything they won’t be solvent. It’s economics. It’s not good.”
Aegis Therapies President and CEO Martha Schram said the company has been preparing for the shift to PDPM for more than a year and is “pleased with how smooth the transition has gone so far.” She said the company is reducing per diem labor and the use of contract labor therapists and has communicated those plans with employees over the last several months.
“That said, it is still very early into PDPM, as we continue to monitor our locations, we may have some markets and facilities that could experience a moderate further reduction in labor hours,” Schram said. “Aegis’ commitment is to base staffing decisions on patient care needs at each location versus any sort of broad actions, therefore, we are analyzing daily, and will make adjustments as we have data that supports that necessity. We have committed to our employees to evaluate current open positions before making any changes to existing labor.”
Schram said Aegis anticipates an increase in the utilization of group and concurrent therapy under PDPM. She added the company recognizes the “value and effectiveness of alternative delivery options based on clinical evidence which supports the efficacy of group intervention with select patients.”
“This is a huge change, and just as we have seen in the past, there are different approaches to implementation, I think it is too soon to say how those will ultimately play out. From Aegis’ perspective I know we employ extremely talented, mission-driven and patient-centered clinicians who partner with us to ensure we are providing the best care possible to our patients,” she said.