Disappearing therapy thresholds

Make certain every therapy visit is billable under PDGM

Therapy for homebound patients may have been a by-the-numbers business in the past, but Medicare's new payment model will force home care providers to more closely align services to patient needs in 2020.

Under the Patient-Driven Groupings Model (PDGM) taking effect Jan. 1, it's more important than ever before to make certain every visit is a billable one, according to Heather Calhoun, Director of Special Projects and Appeals for Home Health Solutions.

In a recent series of webinars titled "The New Role of Therapy Under PDGM," Heather reiterated the importance of effective therapy documentation to justify visits and discussed some of the changes which may be ahead for therapy under a payment model which is not based on therapy thresholds.

Providers are looking to shave time, cut costs and streamline care provision under the new payment model, and some are shifting the overall framework of care, with greater care coordination expectations and pre-determined checkpoints to determine exactly where and when therapy will be used.

Expected changes include new care models, sharing of some duties between nurses and therapists, increased use of assistants and video monitoring, Heather said. Some agencies are changing up some traditional roles, asking therapists to perform functions traditionally performed by nurses, such as wound care.

But the truth is no one is sure just yet how Medicare’s new payment model will re-write the role of therapy in home care. "We’re still in the beginning chapter, with more to come as agencies figure out what does and does not work well under PDGM," Heather said. Cuts in therapy

Some agencies are struggling to find a good fit for therapy under the new model, with layoffs or cuts in services expected. While it’s generally a good idea to look at ways to consolidate care and control costs, Heather cautions agencies that industry experts expect CMS to monitor provider behavior to see who’s making therapy cuts. Agencies experiencing a sudden sharp drop in therapy usage may find themselves under unwelcome scrutiny from CMS. Fair or not, the burden is on therapists to find ways to demonstrate their worth in the midst of this industry uncertainty. "Effective documentation is particularly important, as it can drive care and ensure all therapy visits are billable," Heather said.

Therapy intensity and frequency must align with patient goals. Patient goals must align with patient needs. Patient needs must align with clinical findings and objective, measurable testing. "Therapists have to show how their expertise is a necessary and beneficial part of a patient’s rehabilitation and recovery," Heather said. "In the case of maintenance therapy, therapists must effectively document how their skilled services are prohibiting further decline, or slowing continuing decline." Even after the initial therapy evaluation determines the patient's impairment and need for treatment, therapists must continue to document ongoing medical necessity throughout the episode of care - for every visit, Heather said. Four key areas to demonstrate value

What therapists write has never been more important, and there’s very little room for mistakes. But every patient offers therapists distinct and important opportunities to demonstrate the value of the profession to patient health, safety and outcomes in:

  • The initial eval with treatment plan

  • The reassessment

  • Routine visit notes

  • Progress notes Documentation for each of those areas must show clear evidence of ongoing physiological benefit to the patient (even if the benefit is reducing the risk of decline) and the need for services to continue, Heather said. The three webinars in Heather's "Therapy Under PDGM" series are currently for sale in the Home Health Solutions online store. They may be purchased individually or as a package of three. A digital handbook for therapists on effective documentation is included in the set of three. Visit the store now to take a look!