Pandemic raises questions about impact of Medicare payment restructuring in post-acute
Just a couple of months after CMS enormously altered how skilled nursing centers are reimbursed for therapy services, the pandemic hit and threw long-term care operations into a tailspin.
That makes it hard to identify precisely how the modification impacted therapy services and therapists in nursing homes, scientists say.
A report released in Health Affairs on Monday reveals that therapist staffing levels were cut in anticipation of and after the modification to the patient-driven payment design in October 2019. The new model replaced the long-standing Resource Usage Group payment system, called RUG, with general support from the post-acute care industry. But, after the 4th quarter of 2019, there isn’t dependable information to further track the changes, the authors said.
As COVID-19 spread throughout the U.S., nursing homes were no longer needed to report payroll-based information, leaving unknowns on the long-term results of the PDPM shift on staffing levels.
Compared to July and August, staffing levels of physical therapists fell 5.5%, physical therapist assistants dropped 9.4%, physical therapists reduced 6.1%, occupational treatment assistants fell 10.2% and speech-language pathologists slipped 4.3% throughout September through December 2019, according to the report. Those cuts were “nearly totally” to contract staff.
Agreement staff represented 100% of the cuts to physiotherapists, 92% for physical therapy assistants, 100% for physical therapists, 93% for occupational therapy assistants and 133% for speech-language pathologists, the report found.
When PDPM was very first implemented, Genesis Health care, a nationwide chain service provider, said 585 of its 10,000 rehabilitation staff members were affected by the payment model modification.
The American Physical Therapy Association said that “Prior to the pandemic, the execution of PDPM had an effect on some therapists and therapist assistants’ hours in SNFs. Based upon viewed requirements following PDPM execution, in addition to throughout the pandemic, it is most likely that some companies reduced hours of therapists and therapist assistants while other providers did not.”
In spite of therapist cuts, there were limited staffing increases throughout other positions; there weren’t any gains for occupational therapist aides, signed up nurses or licensed useful nurses. There was a 3.2% increase in physical therapy aides and 0.4% boost in qualified nursing assistants.
The previous Medicare reimbursement model concealed to 720 minutes of treatment for each patient weekly, which critics state incentivized excess therapy. The PDPM model bases repayment on a patient’s condition and what care is needed. It likewise relaxed some of the rules around group therapy, allowing up to 25% of a patient’s treatment to be in group sessions. The report discovered that group treatment sessions increased after the PDPM transition, likely changing more individually therapy sessions.
“It is uncertain, nevertheless, whether decreases represent a “right-sizing” of therapy departments that were formerly developed to provide financially inspired treatment of restricted scientific benefit or a form of cutting corners that limits patients’ access to needed rehabilitation services,” the authors composed.
The American Physical Treatment Association stated group and concurrent therapy mostly stopped during the pandemic, making it challenging to inform whether the type of treatment being used has changed, either from PDPM or the pandemic.
“After the general public health emergency situation concludes, we may see the renewal of group and/or concurrent therapy,” the association stated.
Brian McGarry, assistant professor in the division of geriatrics and aging at the University of Rochester’s Department of Medicine and one of the report’s authors, said the report just gives “one photo of PDPM around staffing.”
“We understand some centers shed treatment staff in action to PDPM. What we do not know is what does that mean for patients, how does that change the quantity of therapy provided,” McGarry stated.
The American Health Care Association and the National Center for Assisted Living, which represents more than 14,000 long-lasting care facilities, could not be grabbed comment.McGarry stated patient-level data that breaks down how treatment was delivered was simply released, which will offer researchers some insight into how patient care altered in the first few months of PDPM.”With COVID, the information on PDPM modifications will be hard to determine,”a representative for the American Physical Therapy Association said. PDPM was suggested to be budget neutral but cuts to staff without matching increases in other staffing means that nursing homes are “probably coming out a little ahead,”McGarry stated, keeping in mind that the absence of working with could be a”yellow flag “worth seeing.” If you’re accruing cost savings, what are you finishing with the cash you’re not spending on them anymore?
“McGarry stated. However provided how underfunded assisted living home were found to be during the pandemic,”that might not necessarily be a bad thing
,”McGarry said. CMS likewise prepares to adjust payment rates as needed. Published at Tue, 02 Mar 2021 01:15:22 +0000