Some therapists argue that new Patient Driven Payment Model rules eliminating artificial cutoffs and minute thresholds have freed them to provide better care. Others dislike pressure to avoid what they argue is more meaningful rehab at higher levels.
But a study published in JAMA Health Forum earlier this year showed that outcomes overall haven’t suffered since the transition, despite less hands-on therapy.
Skilled nursing patients received about 13% fewer therapy minutes after PDPM’s October 2019 launch. At the same time, researchers found the change had little to no effect on outcomes or rehospitalization rates.
“More attention is placed on the desires of the patient, which is excellent,” said Kristy Wikum, president and CEO of
David Tate, chief strategy officer at Reliant Rehabilitation, said that his company’s experience has shown “a gradual improvement in functional outcome scores for patients completing rehabilitation stays in SNFs over the past two years.”
Reliant developed clinical pathways that align with PDPM’s wide variety of case-mix groups.
Hilary Forman, chief clinical strategies officer at HealthPRO Heritage, believes PDPM gave clinicians more freedom to practice and prescribe. She said that it also has helped drive efficiencies in the pursuit of value-based care.
Jintronix co-founder and CEO Mark Evin added that clients are looking at therapy differently now. Instead of just valuing time spent with patients, therapists must emphasize imaginative solutions.
For example, he said, technology is becoming a more important tool.
“PDPM is freeing certain constraints while providing new ones,” he said.
Michael Smith, an independent therapy consultant for long-term care facilities and rehab centers, finds both viewpoints valid.
“The therapists have been able to use the clinical need to justify their care,” he said.“This is rather appealing to those who wanted more control to decide how much therapy was needed versus the need to meet minutes for reimbursement.”