Modern Healthcare

Pandemic raises concerns over impact of Medicare pay restructur­ing on SNFs

- By Ginger Christ

ONLY A FEW MONTHS AFTER CMS massively changed how skilled-nursing facilities are reimbursed for therapy services, the pandemic hit and threw long-term care operations into a tailspin.

That makes it difficult to determine exactly how the change affected therapy services and therapists in nursing homes, researcher­s say.

A study in Health Affairs last week showed that therapist staffing levels were cut in anticipati­on of and after the change to the patient-driven payment model in October 2019. The new model replaced the long-standing Resource Utilizatio­n Group payment system, known as RUG, with general support from the post-acute care industry. But, after the fourth quarter of 2019, there isn’t reliable data to further track the changes, the authors said.

As COVID-19 spread across the U.S., nursing homes were no longer required to report payroll-based data, leaving unknowns regarding the long-term effects of the PDPM transition on staffing levels.

Compared with July and August, staffing levels of physical therapists fell 5.5%, physical therapist assistants dropped 9.4%, occupation­al therapists decreased 6.1%, occupation­al therapy assistants fell 10.2% and speech-language pathologis­ts slipped

4.3% from September through December 2019, according to the report.

Those cuts were “almost entirely” to contract staff.

Contract staff represente­d 100% of the cuts to physical therapists, 92% for physical therapy assistants, 100% for occupation­al therapists, 93% for occupation­al therapy assistants and 133% for speech-language pathologis­ts, the report found.

Despite therapist cuts, there were limited staffing increases across other positions; there weren’t any gains for occupation­al therapist aides, registered nurses or licensed practical nurses. There was a 3.2% increase in physical therapy aides and 0.4% increase in certified nursing assistants.

The previous Medicare reimbursem­ent model covered up to 720 minutes of therapy for each patient per week, which critics say incentiviz­ed excess therapy. The PDPM model bases reimbursem­ent on a patient’s condition and what care is needed. It also relaxed some of the rules around group therapy, allowing up to 25% of a patient’s therapy to be in group sessions. The report found that group therapy sessions increased after the PDPM transition, likely replacing more one-on-one therapy sessions.

“It is unclear, however, whether reductions represent a ‘right-sizing’ of therapy department­s that were previously designed to deliver financiall­y motivated therapy of limited clinical benefit or a form of skimping that limits patients’ access to needed rehabilita­tion services,” the authors wrote.

The American Physical Therapy Associatio­n said group and concurrent therapy largely stopped during the pandemic, making it difficult to tell whether the type of therapy being offered has changed, either from PDPM or the pandemic.

“After the public health emergency concludes, we may see the resurgence of group and/or concurrent therapy,” the associatio­n said.

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 only gives “one snapshot of PDPM around staffing.”

“We know some facilities shed therapy staff in response to PDPM. What we don’t know is what does that mean for patients and how does that change the amount of therapy delivered?” he said.

The American Health Care Associatio­n and the National Center for Assisted Living, which represents more than 14,000 long-term care facilities, could not be reached for comment.

PDPM was meant to be budget-neutral, but cuts to staff without correspond­ing increases in other staffing means that nursing homes are “probably coming out a little ahead,” McGarry said, noting that the lack of hiring could be a “yellow flag” worth watching. ●

“We know some facilities shed therapy staff in response to PDPM. What we don’t know is what does that mean for patients and how does that change the amount of therapy delivered?” Brian McGarry, assistant professor in the division of geriatrics and aging at the University of Rochester’s Department of Medicine

 ?? GETTY IMAGES ??
GETTY IMAGES

Newspapers in English

Newspapers from USA