What are the Medicare guidelines for physical therapy in skilled nursing, and why are they important? Medicare guidelines fall under the jurisdiction of the Center for Medicare and Medicaid (CMS), which governs how physical therapy services are provided in skilled nursing facilities.
Facilities must follow Medicare guidelines to ensure that the residents in their charge receive safe, effective, and high-quality care while promoting their health, well-being, independence, mobility, and quality of life.
The CMS’ Medicare guidelines for physical therapy in skilled nursing facilities include several rules facilities must adhere to when providing physical therapy services, such as:
- Physical therapy services must be provided by licensed physical therapists or physical therapy assistants supervised by a qualified physical therapist.
- PT services must be part of a resident’s tailored care plan, devised collaboratively with the physical therapist and the resident’s physician.
- Therapy services must be deemed medically necessary, reasonable, and designed to achieve specific functional goals for the resident.
- Physical therapy services must be accurately documented in the resident’s medical record via the facility’s long-term care software. This entails documenting all therapy notes, including the initial evaluation conducted during the MDS assessment, progress notes, and discharge summary.
- Therapy services must be reviewed and updated regularly by therapists and other caregivers, ensuring the team meets the resident’s physical needs while working towards their care plan goals.
- Services must comply with federal and state laws, CMS regulations, and professional standards.
Medicare guidelines for modalities and procedures
In addition to the criteria above related to providing physical therapy services, additional application guidelines must also be observed. These are related to physical therapy modalities and procedures, such as:
- Assessment: This requires the ongoing assessment of a resident’s rehabilitation needs and potential for recovery. The assessments are conducted as part of the resident’s tailored care plan and typically include tests and measurements on the resident’s strength, balance, motion, endurance, coordination, and functional ability.
- Range of motion: Only qualified physical therapists can conduct motion tests, as they are directly related to skilled physical therapy services. Therapists will conduct several motion exercises to test a resident’s loss or mobility restriction while identifying the degree of motion lost, the degree to be restored, and the impact on the resident’s mobility and function. Supportive personnel, such as CNAs, can administer passive motion exercises unrelated to a specific loss of function and assist with minor exercises designed to help residents maintain their motion range.
- Therapeutic exercises: These can only be performed by qualified physical therapists. They typically involve physical activities and movements that restore a resident’s function and flexibility while improving their strength and decreasing pain. These exercises are incorporated into a resident’s care plan and are sometimes combined with other therapeutic exercises depending on the resident’s needs and condition, such as:
- Aerobic conditioning
- Balance training
- Range of motion exercises, including passive, active assisted, and active strength training
- Progressive resistive exercises
- Gait training: Gait training involves practicing exercises that strengthen muscles to increase motion range and typically includes three types of repetitive exercises: walking and stepping, range of motion, and strengthening. A physical therapist also conducts a gait evaluation to determine a resident’s walking ability. During a gait evaluation, the therapist will also determine whether the resident’s walking ability is impaired due to a neurological, muscular, or skeletal abnormality, thus requiring physical therapy services.
- Maintenance therapy: This must be conducted under the supervision of a qualified physical therapist. A maintenance program works towards maintaining a certain lifestyle to avoid declining health and ability rather than aiming for improvements through therapy sessions. Maintenance programs require the therapist to assess residents by looking at their clinical condition and how they can prevent or slow down further deterioration. Due to the complexity of the assessments and treatments, therapists must use their specialized knowledge, judgment, and skills to implement a safe and effective maintenance program into their care plan.
- Heat treatments: While heat treatments like hot packs, whirlpool baths, infra-red treatments, and paraffin baths do not necessarily require skilled physical therapists, their expert knowledge, skills, and judgment is valuable for applying these methods appropriately when a resident has a circulatory deficiency, open wounds, fractures, or other complications.
- Diathermy treatments: These specialized therapeutic treatments include ultrasound, shortwave, and microwave treatments prescribed for muscle and joint conditions. They use high-frequency electric currents to stimulate heat generation within body tissues to increase blood flow, improve mobility tissue, and relieve pain, which is why these specialized treatments must be performed by a physical therapist.
Now that we better understand the Medicare guidelines for physical therapy in skilled nursing, we can look at some common challenges physical therapists and skilled nursing facilities face in observing them.
The Challenges Facing Skilled Nursing Facility Physical Therapy
A skilled nursing facility provides rehabilitative and 24-hour nursing care for residents who need ongoing medical attention. In a skilled nursing facility, physical therapy treatment is a major part of many care plans. There are several challenges that physical therapists (PTs) face when working in a skilled nursing facility, including the following:
Cuts in funding
In 2022, there was a CMS Physician Fee Schedule (PFS) funding cut, impacting physical, occupational, and speech therapy services in skilled nursing facilities. This has created great uncertainty for physical, occupational, and speech therapist assistants seeking to perform their jobs. As a result, some have chosen to leave long-term care and enter other sectors.
The cut has also dissuaded physical therapist assistants from joining the industry. While some facilities have been forced to reduce employee pay or employ fewer therapy assistants, impacting the ongoing staffing crisis with reduced caregivers.
Another negative impact of this cut is the 15% reduction in reimbursement to the Medicare Part B physical therapy rates for services provided by physical therapist assistants. The result of losing these resources means that facilities and therapists cannot provide the same amount of therapy, leading to a lower level of care for residents, impacting the success of their treatment.
Since February 2020, the long-term care industry has lost nearly 14% of its workforce (approximately 229,000 caregivers), per the Bureau of Labor Statistics. This has forced many facilities to limit new admissions and also prevented residents under their care from accessing the care they need.
Under such conditions, physical therapists experience poorer working conditions, limited support staff, and coordination problems due to unavailable healthcare professionals. This results in therapist workloads being unmanageable, leading to insufficient care.
Limited time with patients
With less funding, physical therapists in SNFs do not have sufficient time to spend with each resident due to their high caseloads and the need to manage multiple residents simultaneously. This can make it difficult to provide personalized care and fully address residents’ needs so they can reach their treatment goals.
Since the introduction of the new Medicare guidelines for physical therapy in skilled nursing facilities and the funding cut, therapists nationwide have reported a reduction in therapy sessions and treatment times, prompting facilities to scale back the treatment given to patients, lay off therapists, or switch them to part-time contracts.
More complex patient needs
Residents in SNFs now often have complex medical needs, such as multiple chronic conditions, cognitive impairments, and functional limitations. However, many physical therapists and therapist assistants are not adequately trained to manage people with behavioral issues and mental illnesses, such as dementia and schizophrenia.
Physical therapists and other long-term caregivers need better training in behavioral management strategies to be more equipped to manage residents who suffer from various types of dementia, depression, and anxiety.
PTs in SNFs must also deal with administrative tasks, such as documentation and billing, which can be time-consuming, especially if the facility is not using a long-term care EHR system. This reduces their interaction time with residents and can lead to burnout. That is why facilities must invest in efficient and reliable nursing home software with automated processes to reduce administration duties and time.
Overall, skilled nursing facility physical therapy can be challenging due to the complexity of a resident’s needs, limited resources, and administrative burdens. If these challenges are managed, therapists can make a major impact on the lives of those in their care. In the next section, we will look at the benefits that physical therapists bring to skilled nursing facilities and how they can improve resident care.
Contact us here to learn how our long-term care software can be used to aid physical therapy services.
Benefits of Physical Therapy Through Medicare Skilled Nursing Coverage
Physical therapy is a critical aspect of Medicare skilled nursing coverage because it provides skilled nursing residents with the rehabilitative care they need to regain mobility and function.
Physical therapy uses exercises, stretches, and other techniques to improve strength, flexibility, and range of motion. These services are often paid for through Medicare, which is the reason for the discussion on Medicare guidelines for physical therapy in skilled nursing above. But what are the benefits of physical therapy, and how does it impact physical and occupational therapy in nursing homes?
The benefits of physical therapy in long-term care settings include the following:
- Improved quality of life: Physical therapy and skilled nursing care help residents recover from injuries and illnesses, allowing them to regain independence and mobility. Such treatment focuses on four key areas— strengthening, pain release, healing, and mobility, ultimately improving residents’ quality of life.
- Convenience of care: Residents in a skilled nursing facility have better access to care because the on-site therapy sessions are located. This reduces travel time, making it more convenient to attend therapy sessions. And when residents require multiple therapy sessions per week, caregivers can easily monitor their daily progress while ensuring residents are following the care plan in such settings.
- Easy access to equipment: One limitation of physical therapy in external locations is the equipment needed during therapy sessions. However, when residents are admitted into a skilled nursing facility, physical therapy equipment is often on-hand and does not need to be transported. This automatically improves the quality of care for residents because they have full access to specialist equipment when needed.
- Cost efficiency: Under Medicare’s physical therapy requirements for skilled nursing facilities, residents in SNF care are covered for the first 100 days of care per benefit period. This coverage includes physical therapy services, reducing the financial burden on residents. Of course, beyond the 100 days, Medicare will cease payments, returning the financial responsibility to the resident or their family.
- Personalized care: When a skilled nursing facility adopts an effective senior care software system, therapists can more easily provide personalized care to address the resident’s needs. This is possible because the long-term care software houses all clinical data used to create a tailored care plan, thus ensuring residents receive the care they need for a full recovery.
Residents residing in skilled nursing facilities and needing physical therapy have better access to care and on-site equipment, enabling them to recover faster, improve their quality of life, and reduce healthcare costs.
The Importance of Following Medicare Guidelines for Physical Therapy in Skilled Nursing Facilities
Following Medicare guidelines for physical therapy in skilled nursing is crucial because it ensures that residents receive the care they need to recover and improve their quality of life. The guidelines provide specific criteria for eligibility and applications for physical therapy services, ensuring that patients receive appropriate care.
If facilities follow Medicare guidelines, residents will recover faster, thus reducing the financial burden on facilities, residents, and their families. Additionally, facilities can avoid legal or malpractice issues when following Medicare guidelines.
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