When the Patient-Driven Payment Model (PDPM) was enacted a year ago, no one anticipated a pandemic. However, many see a value to this model during such a crisis.
“There is already a process in place to sort out how therapy delivery might change based on the re-emphasis on what patients need,” says the American Health Care Association/National Center for Assisted Living’s Daniel Ciolek. Under PDPM, he notes, the focus is on medical needs, goals, and outcomes, not on the volume of therapy provided, unlike the Resource Utilization Group-IV (RUG-IV), the reimbursement model that PDPM replaced.
“The amount of therapy and how it’s delivered has changed dramatically in recent months, and the cost of care delivery has skyrocketed because of the pandemic. It would have been crushing to the industry if we were still under RUG-IV when the pandemic occurred.”
The Good Samaritan Society’s Dawn Andresen observes, “The biggest impact of PDPM is that it has provided more flexibility within our ability to provide concurrent therapy. However, as a result of maintaining social distancing and infection control efforts, we’ve mostly had to eliminate that as a treatment. CMS [Centers for Medicare & Medicaid Services] offset this challenge by waiving the three-day hospitalization requirement, allowing us to provide therapy services earlier.”
Kelly Cooney of the National Association of Rehabilitation Providers and Agencies says, “Thanks to PDPM, we are better able to assess various issues happening with the whole patient. It has created more of a team focus on areas that have been identified as needing support during the pandemic. It also improves continuity as the patient moves from setting to setting or in and out of a COVID unit.”
While PDPM is a much better reimbursement model for a pandemic, Ciolek says, “There are still some bugs to be worked out.” Cooney cautions against reducing therapy services as a cost-savings measure right now.
“Facilities are bearing a lot of extra costs now for staffing, PPE, etc.,” she says. “But this isn’t a time to cut back on therapy or other services that residents need to regain and maintain physical and mental functioning. Instead, we all need to work together to continue to remove some of the obstacles that interfere with access to care.”