Therapy utilization under PDGM

Changes are coming -- but home health's new payment model won't be the death knell for therapy utilization

Editor's Note: This blog post kicks off a series of summer posts examining the changing role of therapy in home health under PDGM. Look for these posts each Monday. Medicare's new payment model is expected to usher in scores of top-to-bottom changes for home health in January, from the types of patients home health agencies seek to the severance of some long-standing relationships with referral sources. One of the most talked-about and anticipated changes under the Patient-Driven Groupings Model (PDGM) is how agencies will adapt to a payment methodology driven by patient characteristics rather than therapy volume. Will agencies shift the bulk of their focus to sicker patients, often newly released from the hospital, whose serious medical conditions, illnesses or wounds will require more skilled nursing care and pay higher reimbursement rates? How will PDGM affect agencies which have traditionally served patients whose post-surgery status or injuries require physical therapy to restore mobility? These are important questions. A recent survey of 685 home health providers by the National Association for Home Care & Hospice indicated that more than half of the agencies surveyed expect to decrease therapy utilization next year, with about a quarter of the respondents reporting that they plan to replace costly in-person therapy visits with increased use of telehealth tools. "This is one of the major issues facing home care providers who are looking toward next year's implementation of the new payment model," said J'non Griffin, owner and president of Home Health Solutions. "And it's a thorny one, with a lot of unknowns at this point. We're definitely going to see much more of an industry-wide emphasis on skilled nursing care and less therapy utilization. "But it's important for home care providers to understand that therapy is still going to be an integral part of home health," J'non said. "Therapy is important. It rehabilitates patients, reduces risks, prevents further decline and improves overall patient outcomes. None of that is going to change under PDGM, and therapy will still be needed." A Cinderella story Therapy has the potential to be something of a Cinderella story under the new payment model: highly favored in years past, then temporarily considered of less value under changed circumstances until its true value is revealed through a major industry transformation process. "In this case, the transformation will need to be in the way the home care industry uses therapy not as the revenue driver but as an essential and valuable component of the assessment and care planning processes," J'non said. "We're going to need to transition away from unnecessary utilization and rely on therapy as part of a thorough and effective overall care coordination process to improve patient outcomes." Skilled therapy services can and should continue to play a vital role under PDGM as long as the services are medically necessary to restore function to a patient or to prevent decline, J'non said. But some important changes may need to take place in the current home health mindset in order for therapy to successfully make a Cinderella-like transformation, J'non said. "One of the most important pieces of a successful transformation will be learning to effectively document the need for skilled therapy services, " she said. "Right now, we're still falling short in this area. There must be clear evidence that therapy is supporting the Plan of Care, and that each visit is an integral step toward achieving the home care episode’s patient-centered goals." Next Monday: Therapy's role in care coordination under PDGM