Why Therapy Still Matters in PDPM

Imagine an industry where reimbursement is not based on the volume of therapy treatment minutes. Instead, therapists care for patients and drive outcomes-based exclusively on clinical need. This is where PDPM makes its grand entrance on October 1, 2019.

Yaffa Liebermann, PT, GCS, CEO has stated for decades as a practicing Physical Therapist that “treat first and the money will follow”.  We are excited that now our skilled care will be measured by the evidence-based therapy we provide and the outcomes we achieve for our patients.

We are firm in our belief that therapy will continue to be just as important in driving revenue and necessary outcomes including patient/family satisfaction as ever before with much more freedom to focus on the patient as part of the entire interdisciplinary team.

Reasons Therapy Still Matters:

The requirements to be able to access skilled care following an acute-care stay under Medicare Part A does not change under PDPM. Remember that patients must be in need of skilled services in an SNF for care to be covered. Under PDPM, the following CMS rules will still hold true:  A resident must require skilled nursing services or skilled rehabilitation services (see §§30.2 – 30.4) on a daily basis (see §30.6); and can be provided only on an inpatient basis in an SNF (See §30.7).  Also, services delivered are reasonable and necessary and are consistent with medical needs, accepted standards of practice as well as the nature/severity of the illness or injury.

Post-acute patients and their families still want, need, and expect world-class therapy services.

Facilities still want to maintain or achieve the coveted 5 Star Rating. Short and long-stay Quality Measures will continue to impact SNF’s Star Ratings, and therefore affect eligibility for bundled initiatives participation/preferred provider networks and referral/admissions volume. Therapy offers a non-pharmacological approach to resolving many short and long-stay QMs and/or fundamentally drives programs/interventions to help SNFs maintain above-average measures for the majority of QMs.

In a world where reimbursement will be determined by how patients are cared for, the ability to track and analyze outcomes will be critical.

Need support? Prime Rehabilitation Services remains is a trusted, local partner with solid PDPM readiness.

The expertise of physical, occupational, and speech therapists will always be sought after because therapy is – undeniably – a necessary component of achieving the best possible patient outcomes.

Yaffa Liebermann, PT, GCS, CEO (not in photograph) and Chris Nigroni, OTR/DOR sharing PDPM Readiness information at the Administrators Meeting in Westfield, NJ, September 19, 2019.