Can you comment on the Patient Driven Payment Model’s flexibility? Facilities might reduce traditional therapy while adding group/social exercise classes and then have therapists guiding the curriculum there. 

Providing group and/or concurrent therapy is a good idea under PDPM, both as a benefit to the resident as well as a way to control therapy costs. 

Group therapy is defined as treatment of two to six patients who are performing similar activities that are part of their plans of care regardless of payer source. One example is an exercise group to prevent falls or improve cognition.

When utilizing group therapy, note the following: First, ensure that group therapy is included in the order and on the plan of care. Second, document why group therapy benefits this resident. Is it a socialization benefit? Is peer motivation a factor in reaching goals? 

Also, document how group therapy helps the residents move toward their goals. Keep in mind activities must be of sufficient complexity to require the skills of the clinician. Group therapy may not be appropriate for all residents.

When establishing an exercise group, ensure that activities are not perceived as routine, repetitive or restorative. Note, the Centers for Medicare & Medicaid Services is monitoring the amount of group and concurrent therapy minutes being reported on the MDS. If more than 25% of minutes reported are group or concurrent, an error will be registered on the validation report.  

Although there currently is no penalty for providing more than 25% of minutes, CMS does refer to these providers as being “non-compliant.” 

PDPM offers flexibility to individualize the care to the resident’s needs. Group therapy can provide a beneficial, cost-effective way to do this.