PDPM… Is The Apocalypse Coming?

Written by: Vanessa Cardenas, COO

I joined Prime Rehabilitation Services shortly after PPS (Perspective Payment System) was introduced.  I had heard that when PPS was introduced, many therapists felt this would single-handedly destroy the therapy industry as it is money-focused.  What was I getting myself into?  It was Yaffa Liebermann, PT, GCS, CEO that eased my concerns during my interview, when she said, “Treat the patient well and then the money will follow”  Intently watching both my grandparents treated by the most amazing therapist during their joint stay at a nursing home over their 54th wedding anniversary, I was overwhelmed with a desire to be part of the therapy world.  This one therapist changed my life and PPS dramatically changed the lives of many therapists.  Looking back, I am proud to be part of a company that fully embraced the new system and managed it very well, all while providing skilled quality care to its patients.  “Treat and the money will follow” (my condensed version) continues to play on repeat all these years later.

 

It is my belief that PDPM will be like that.  Chaos at first but, after the dust settles, we will have learned creative ways to achieve as good or better outcomes with fewer resources for less reimbursement.  Therapy simply cannot be phased out because it remains necessary for a patient’s recovery.  Therapy remains a crucial ingredient for solid patient outcomes and positive patient satisfaction reports. Both are very important for continued referrals, especially in this “review” and “likes” abundant digital society.

Many trade publications and articles have declared that PDPM will decrease Medicare Part A minutes and reduce revenues by 35%.  Regrettably, I do believe this is a fair assessment based on current occupancy rates.

Under PPS, therapy was necessary for patient recovery while simultaneously generating increased revenue which helped to offset the costs of 24-hour care. While therapy services remain necessary for the patient’s recovery, it no longer directly correlates with reimbursement as it did under PPS.  Therefore Medicare Part A treatment time will be reduced to offset the drop in revenue.  While there is favoritism as well as a financial benefit to the provision of group treatments and concurrent setting (capped at 25% of total treatment time) the therapists required to do those treatments will also decrease.

The sky is suddenly falling…but is it really? 

The bad news for all therapists is there will be less therapy given per Medicare Part A patient, regardless of the intended purpose of PDPM…it’s just the unfortunate outcome of economics.

The good news for all therapists is there will be many, many more needing the services of a therapist in a variety of settings with varying payer sources.  Our population, as a whole, is getting “sicker”, whether it is obesity, COPD, heart disease, diabetes, etc.  The “silver wave” is upon us, “baby boomers” are approaching their golden years.  Every ten years moving forward, there will be at least 10 million more seniors than the previous decade (Y2010, 42 million seniors age 65 or older / Y2020, 55 million / Y2030, 70 million / Y2040, 80 million) and with the life expectancy increasing, each decade will have a large pool patients.  Simply put, a sicker society that lives longer.

The way I see it, in the long run, even if the duration of a therapy session is trimmed per patient, there will be more patients that will benefit from the skills of a therapist.

I must say that I do find this trimming all over healthcare these days.  Now doctor appointments are scheduled on the 10 minutes mark.  “Your appointment is scheduled for 11:40 on XX or I have 2:20 on XX”…never mind that the waiting rooms are filled with many more patients all staring at the same obnoxiously large clocks strategically placed to be front and center.  You are still “required” to arrive 15 minutes to fill out (who’s going to pay for your visit) paperwork, but this is also the “buffer” zone to keep the 6 patients per hour flowing like clockwork.

The challenge facing the therapy industry is to think of creative ways to get as good or better outcomes with less time, resources, and reimbursement per patient.

I strongly believe that therapists and therapy companies will face this challenge head-on, just as they did with PPS.   I am also confident that those who continue with a “treat the patient and the money will follow” mindset and are nimble to change, will do the best for their patients and even thrive under PDPM.  We take great pride that our therapists are well prepared.  With encouraging feedback from our Directors of Rehabilitation, our President, Eli Liebermann, Ph.D., MBA, President did not want to dictate minutes for the new system but rather have the treatment decisions came from and delivered by our therapists based on patient characteristics and needs and not by a “corporate” mandate.

Chaos at first, then the dust will settle…we get up, dust ourselves off and focus on the patient…it’s even in the name, Patient-Driven Payment Model.