PDPM – A Physical Therapist’s Perspective with Decades of Experience

By: Yaffa Liebermann, PT, GCS, CEO

I would like to share my personal opinions and feelings about the upcoming transition to PDPM.

I am a physical therapist that already had years of experience when I was introduced to the provision of therapy within the sub-acute/nursing home environment.

I accepted the job as a PT, Clinical Supervisor at Paragon Rehabilitation and was well informed during my initial orientation to Medicare A,  B, and Medicaid.  I started my job but was not able to fully comprehend the difference between A the B.  I came to my supervisor, Linda, after two weeks and I asked her for further explanation.  She was so surprised that I did not remember the difference between her long and detailed orientation/introduction.  My reply was: “Well Linda, I am treating the patients as needed but I do not know what is the difference in billing.  We have two options: 1) I will continue to treat without fully comprehending the billing information or 2) I will understand a little better the way that the insurance charges”.

Of course, she explained it to me again and I continued to treat as needed with a better understanding of the payment structure under Medicare A and B.

A few years passed and in 1996 we founded Prime Rehabilitation Services. Then came a time that nurses received the reimbursement for new admission and therapy was not provided for 7 days. This changed quickly because the patients stayed in bed and did not get stronger until therapy started to provide their magical skilled care. Two years later, the PPS system rolled out. The nursing home industry was panicking;  companies wrote 3” binders of protocols of how to treat according to PPS rules.  I told my daughter, an engineer and COO of our company, that I need a mathematical equation for how to treat patients within this new system that would benefit both the patients and the facilities based on the RUG categories.   She produced a one-page chart with different discipline combinations – therapists could choose treatments strategies in line with the new reimbursement system that gave options according to the individual patient needs.

Next, concurrent and group treatments were introduced.  I loved the concept of group therapy! The patients were happy; they supported each other; they learned from each other; and they performed exercises in preparation for the actual functional treatments like transfer, gait, and toileting.

Unfortunately, Medicare A and B cut off the group by not paying much for this skilled training.  I believe that the reason for this was that some therapists provided only group therapy and not individual treatments.  I was so disappointed group treatment was eliminated because it was incorrectly used by some therapists.

SLP treatment: only dysphasia was considered skilled care by therapists in the sub-acute / nursing home.  CMS questioned the cognitive treatment due to the fact that patient in nursing homes are cognitively challenged.  CMS changed its stance and now SLP treatment and cognitive treatment are key to improving the patient’s ability to express his needs.

Time passed and we are on the precipice of PDPM era.  Suddenly I hear statements like PDPM is coming and real minutes per treatment will be provided to the patient and not by RUG level.

I disagree with this statement as we have always provided therapy per the needs of the patient. When patients are admitted from the hospital, they are very weak and need strengthening in order to make them stronger and resume their functioning.  We need the minutes to treat as per the patient’s needs.

I am very happy and pleasantly surprised that group treatment is part of the PDPM. The patients will benefit from this therapy structure once again, they will get better sooner and will be stronger.

The world is changing, evolving and updating, and so is CMS.  It makes minor changes to rules every three months and major changes every October 1st.  We learn how the reimbursement changes and adapt to it. It is another mathematical equation but therapy remains to the reach goals and serves the needs of the individual patient.

I am proudly serving patients in nursing homes for the last 27 years of my life and have always treated patients alongside wonderful caring therapists with great management to direct us.

We followed the current need and created Mobile Therapy Services for home care. This is the direction from CMS and we are following it.

Whatever direction CMS leads us, we will take the time to learn, understand and adapt to continue to serve the patients’ needs. It changes billing with different equations but skilled therapy will continue to be provided.  Therapy is not deemed emergency care but it is changing life quality to ensure the person will continue to function at their optimum level.  We will always treat to improve patients ability and help them to restore their function.