Rehab Therapists Applaud Results from PDPM Outcomes

A recent study measured the impact of the new Patient-Driven Payment Model (PDPM) that was introduced in October 2019. McKnight’s reports researchers discovered nursing home residents received 13% less therapy minutes, but this did not adversely affect outcomes or rehospitalization rates.

This confirms that the Medicare payment system was as effective as necessary six months before the onset of the COVID-19 pandemic and shortly after. Initially, the same group of researchers had found that therapy staff had decreased by about 5% due to the conversion from the therapy-based Research Utilization Groups (RUGs). The purpose of this study was to determine whether provided care was affected.

Momotazur Rahman, Ph.D., lead researcher of the Department of Health Services, Policy & Practice at Brown University’s School of Public Health, stated, “We didn’t see any changes in the ADL scores at discharge. We tried it many ways to see if we were doing anything wrong, and the result was no change. That would imply that there was too much therapy provided before.”

The study assessed beneficiary summary and MDS records of over 201,000 fee-for-service Medicare patients. Of those, about 25% were admitted after the PDPM went into effect. The primary focus was patients with hip fractures. The main assessment points were admission day data, 5-day scheduled assessment and discharge data.

After the new PDPM, total net therapy minutes decreased by about 12 minutes or 13 percent. Therapy minutes included physical, occupational and speech therapy services. Brian McGarry, Ph.D., researcher of the University of Rochester’s Department of Medicine and a non-practicing physical therapist, stated, “We’re finding no significant changes – no harm so that they’re being hospitalized more or have to stay in the SNF for longer periods. In general, it looks like PDPM was working largely as intended in the intermediate term. Then COVID hit, so the effects of PDPM long-term will remain a mystery for a while.”

He also stated the results clarified the ineffectiveness of the RUGs system. He explained, “If therapy was being dispensed strictly on need factors, you would expect normal distribution patterns, that is a bell curve based on clinical presentation and therapists tailoring amounts of therapy to individual needs. Clearly, under the RUGs that was not the case. There were targets therapists were steering to hit, to maximize reimbursements, and they were very successful in doing that. PDPM overnight took that distribution and returned it to what we consider normal distribution. Now therapy minutes are distributed clinically.”