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Understanding PDPM from a Therapist's Perspective

Posted by Nick Hicks PTA, RAC-CT, Vice President of Operations on Oct 10, 2019 5:02:53 PM

Topics: Clinical Consulting, pdpm

Physiotherapist giving physical therapy to senior male patient in clinic

Extra…extra…read all about it: Therapists are being laid off across the nation!

Despite the alarming nature of this fictitious headline, the truth is, not all therapy companies have elected to cut staff in light of PDPM.

Yes, it is true—incentives for reimbursement have realigned under PDPM. The new payment model no longer gears reimbursement toward optimizing therapy minutes. But keep in mind: The therapy profession has never been about providing optimal minutes; rather, it has been about providing optimal outcomes. Trinity Rehab has been set up for success under PDPM since its creation in 2013, focusing on its employees, partners and the patients we are privileged to serve every day. Therapy companies now must allow that unproductive time for communication and collaboration will ultimately lead to more success for the provider and themselves.

Triple check, daily or weekly Medicare meetings, and utilization review (UR) are all essential to maximizing and capturing reimbursement under PDPM. They also aid in case managing each individual care plan. Under DPM, therapy will need to collaborate with providers on all aspects of care, not just therapy. Having the tools and training is critical. Discovering non-therapy ancillaries (NTAs), providing restorative care, calling on hospitals and PCPs, participating in BIMs training and Section GG discussion, and case management are all essential to being successful under PDPM with therapy.

The focus on meetings has always been a “hurry up” philosophy and “get therapy out fast so they can focus on patient treatments.” That therapy cannot attend meetings due to treatments is NOT an excuse that should ever be accepted; it promotes a culture that providers should never allow. Recent news of layoffs might put some providers in that exact scenario if the therapy department is stretched too thin and labor hours are expected to only be spent treating. Nonproductive time for therapy departments should be spent assisting providers managing the PDPM process through extensive, and sometimes time-consuming, discussions—but ultimately leading to improved outcomes and reimbursement.

PDPM has created an opportunity for providers and therapy departments to develop creative and successful restorative programs for short-term and long-term patients. Currently, Trinity Rehab is working with multiple providers in different locations assisting in restorative nursing management. This includes managing the entire process with the therapy department in conjunction with the RN, streamlining caseload and treatments with long-term and skilled patients. Education to nursing and therapy staff is a must in an ongoing process for successful management of the restorative nursing program. Providers have seen more skilled and long-term patients attending meals and activities; they have witnessed a decreased in falls, and marked improvement in  Quality Measures (QMs), satisfaction surveys and Medicare spending per beneficiary (MSPB)—all related to a cohesively managed therapy-driven restorative nursing program.

PDPM requires a team approach from every angle to encompass the individualized care plan for each patient. Therapy departments should not be sifting through the “open positions” at home and wondering if they too will be a victim of PDPM. Instead, they should be working in conjunction with providers to creatively think of how to maximize the success of each patient. Our profession consists of intelligent, creative, licensed professionals who offer much, much more than “just providing therapy.”

The utilization of therapy has not changed, just how therapy is utilized. Providers should embrace it. The professionals who drive outcomes for the facility should have the opportunity to embark on new challenges that align with providers’ successes, not sent home. Moving forward into PDPM, innovating within the landscape of post-acute care, Trinity Rehab has not changed its message: “Your success is our success.”

Contact Richter

Do you have questions about Medicare Advantage Plans under PDPM, or other LTPAC clinical challenges? Call Richter’s clinical education consultants at 866-806-0799 to schedule a free consultation.

Guest blogger Nick Hicks PTA, RAC-CT, is Vice President of Operations for Trinity Rehabilitation Services. For more information, email Nick.Hicks@trinityrehabservices.com, call 330-663-1173 or visit https://www.trinityrehabservices.com/.