The Patient-Driven Payment Model was first implemented in October of 2019, and since then it has significantly impacted long term care and those who work in it. One area that has been particularly affected are the number of PDPM therapy minutes recorded.
Under the previous RUG-IV model, reimbursements to Skilled Nursing Facilities (SNFs) were determined according to the number of therapy minutes a nursing home resident received. In this way, RUG-IV did not fully consider the wide range of clinical characteristics that impact the resources used for residents.
By contrast, the new PDPM system reimburses SNFs based on the resources each resident needs per day rather than the number of minutes of PDPM therapy received. Under PDPM, long term care care is classified into more-nuanced groups, or, five case-mix, adjusted components:
- Physical Therapy (PT)
- Occupational Therapy (OT)
- Speech-Language Pathology (SLP)
- Non-Therapy Ancillary (NTA)
- Nursing component
PDPM, therefore, focuses more on resident care outcomes than PDPM therapy minutes. Skilled nursing facilities are encouraged to focus on the quality of care and care outcomes over the quantity of care services provided.
So how effective was the change? Upon the implementation of the CMS’ new reimbursement system, the Center for Medicare Advocacy noted that PDPM therapy minutes decreased from 91 minutes per resident per day in 2019 to 62 minutes per day in 2020, more than a 30% reduction.
And yet, SNF reimbursements under PDPM increased by approximately 5%, or $1.7 billion in FY 2020, which means the long term care industry is getting more of the funding it actually needs. Of course, this change was not good news for everyone. A study published on Jama Health Forum determined that with less emphasis being placed on PDPM therapy minutes, therapy staff in nursing homes and other facilities were reduced by as much as 5%. Still, the study noted that resident care outcomes were not negatively affected by the reduction in therapy staff and therapy minutes.
Recommendations for PDPM Physical Therapy
PDPM physical therapy is one of the categories that saw a decrease in spending as facilities became less concerned with the number of PDPM therapy minutes. This has resulted in nurses and administrators focusing on maximizing the use of their care plan software, so that they can create effective care plans for better resident outcomes.
External therapy providers can no longer expect to see as many residents as before. Other effects that PDPM has had on therapists include less demand for therapists and therapy services and even perhaps unemployment. Due to a decline in the perception of the need for therapists, the American Physical Therapy Association (APTA) advises physical therapists to clearly demonstrate the value of their services to residents, their families, and long term care facilities. They also recommend that physical therapists take the following actions:
- Promote active treatment plans: Active treatment plans focus on interventions and activities that residents can perform to improve their functional abilities. They include abdominal exercises, stretching and flexibility exercises, and weight loss exercises. Active treatment plans tend to have a greater impact on pain, mobility, and overall quality of life, which therapists can promote to get more seniors into their programs.
- Prescribe strengthening exercises: Current research suggests that strength training combats weakness and frailty in seniors. If practiced regularly (two to three times a week), strength training will preserve bone density, increase muscle strength, increase vitality, and enable seniors to live independently again. Strength training has also been linked to reduced risk of osteoporosis and alleviates symptoms of heart disease, arthritis, and type 2 diabetes.
- Discourage bed rest for seniors with deep vein thrombosis (DVT): Studies show that acute DVT impacts a senior’s quality of life and induces post-traumatic growth. PDPM is more focused on patient outcomes, and bed rest in such cases would result in negative outcomes for long term care residents. It is the job of therapists to help residents remain active.
- Avoid using whirlpools for wound management: Whirlpools are a type of non-selective mechanical debridement. Using whirlpools in wound management creates the risk of bacterial cross-contamination, tissue damage from high turbine forces, and limb edema complications. Therapists today should be active in using other forms of hydrotherapy, such as directed wound irrigation or a pulsed lavage with suction.
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What Does PDPM Mean for Therapists?
So what does PDPM mean for therapists? Therapists now need to focus more on providing quality care and services that lead to better patient and resident outcomes. The days of being able to bill for PDPM therapy minutes without much reservation are gone, and therapists need to find other ways of demonstrating their value.
As mentioned above, this includes promoting active treatment plans, prescribing strengthening exercises, avoiding bed rest for seniors with DVT, and avoiding the use of whirlpools for wound management. For therapists looking to understand PDPM fully, a PDPM cheat sheet from a reputable long term care software provider can prove to be invaluable for their PDPM physical therapy needs.
Meanwhile, new nurses in long term care facilities may need PDPM training courses before they can fully understand how PDPM works. One tool that could prove to be invaluable to long term care facilities is Experience Care’s PDPM Maximizer software, which will be released later this year. This LTC software scans patient documentation for any missing diagnoses. It then uses state-of-the-art AI technology to identify keywords and recommends missing diagnoses for MDS coordinators and, subsequently, physicians.
The PDPM Maximizer is designed to integrate with Experience Care’s long term care EHR, so doctors can instantly review recommended resident diagnoses for approval. By using this software, nursing homes can save up to 75 hours per month on documentation while also increasing their reimbursements by thousands of dollars per patient per month.
PDPM Therapy and the Future of Long Term Care
PDPM is a new reimbursement method in long term care that is patient-centered and outcome-focused. As a result, PDPM therapy minutes are no longer a factor in the calculation of reimbursements for SNFs. Nurses, regardless of their experience in the industry, may need to undergo PDPM training to fully understand how PDPM works. One tool, in particular, that could prove to be invaluable to long term care facilities is Experience Care’s PDPM Maximizer, which helps increase their reimbursements by scanning patient documentation for any potential missed and passing that information along to a physician.
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