The payment system prior to PDPM, RUG-IV, allowed SNFs to bill therapy services they deemed necessary, but some took advantage by ordering superfluous therapy services to gain additional reimbursement from Medicare. PDPM seeks to stop this practice. The new payment model states that therapy minutes cannot account for more than 25% of services rendered to a resident.
Because therapy services can no longer yield as much reimbursement from Medicare, some SNFs have resorted to laying off therapists, as their presence is no longer increasing revenue via Medicare reimbursement. These layoffs have the potential to put a strain on both therapists and residents, as it means more work for employed therapists and less personal attention for the residents receiving therapy.
"Yes, this is a new payment system, but it doesn’t change the reality that staffing and service delivery must continue to be grounded in quality patient care," said Kara Gainer, APTA's director of regulatory affairs on its webiste. The association released a one-page handout on the issue.
Gainer said that some of the most important elements of PDPM are the things that haven't changed under the new system.
"Absolutely nothing changed between September 30 and October 1 [the startup date of PDPM] about patient needs in SNFs, or the value of physical therapy in meeting those needs," Gainer said. "PDPM is predicated on the idea that rehabilitation professionals will exercise clinical judgment and furnish reasonable and necessary services to patients." She also cautioned SNFs that any dramatic change unrelated to patient needs will gather the attention of CMS, so SNFs should be mindful of their actions.
A petition is calling for therapists to take a stance against SNFs reducing their therapy services for monetary reasons. In part, the petition states that because of the cut in payment and treatment minutes, some SNFs now mandate group therapy sessions over one-on-one therapy, whether or not therapists believe it to be in a resident’s best interest.