How many minutes of therapy should be provided, according to diagnosis?
This is a question I have frequently been asked since the onset of PDPM. There are no hard and fast rules about what diagnoses should or should not receive therapy — or how much.
Our industry has been focused on minutes for so long that it is a challenge to get clinicians out of that mind-set. All care should be individualized.
If you have a resident with a hip fracture, diabetes and COPD and compare him or her to a resident with a hip fracture, history of a cerebrovascular accident with hemiplegia and chronic pain, the two will require and tolerate very different plans of care. The clinician should determine what that plan of care should look like.
Remember, the Centers for Medicare & Medicaid Services is monitoring therapy minutes as well as quality outcomes. This brings a new level of risk for Recovery Audit Contractor record requests.
Other areas to focus on in 2020 are the SPADES (Standardized Patient Assessment Data Elements). The program will expand with data collection beginning Oct. 1, 2020, for the new measure, Transfer of Information to the Provider-Post-Acute Care Measure. This looks at timely transfer of health information when the resident is transferred or discharged. The second measure will be the Transfer of Health Information to the Patient. This looks at whether a resident received a medication list when they were discharged to home, assisted living, home health or hospice. The MDS will be updated to capture this information.
2020 will not allow facilities to relax. I anticipate “tweaks” to PDGM. The Value Based Purchasing program is still in play. If you have not worked to reduce rehospitalizations, this should be part of your QAPI program.
From the December 2019 Issue of McKnight's Long-Term Care News
