Despite Speech Push, Physical and Occupational Therapy Have Key Role Under PDPM

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Speech therapy has taken center stage in discussions about the new Medicare payment system for skilled nursing facilities, but therapists and operators say providers can’t ignore physical and occupational therapy services as they adapt.

In the months after the Centers for Medicare & Medicaid Services (CMS) announced the new Patient-Driven Payment Model (PDPM), speech therapy quickly became the belle of the ball for one vital reason: consistent reimbursements. Under PDPM, providers will see a 2% reduction in payments for PT and OT starting on day 21, with further 2% cuts every seven days thereafter. The reimbursements for speech services, however, will not decline after the 20th day of a resident’s SNF stay.

“CMS has determined that they believe the need decreases, and so there should be a lower payment,” Josh Pickus, CEO of therapy software provider Optima Healthcare Solutions, told SNN back in November. “They have not done that with speech. With speech, you get a consistent rate throughout the period, and so at some level, speech is even more attractive.”

But therapy professionals also noted that the reduction in payment starting on day 21 isn’t necessarily harsh enough to force major changes in provider behavior — and that capturing those effective PT and OT hours remains important for both reimbursements and resident outcomes.

“Really, if you look over the course of time, it is a minimal impact overall to revenue,” Michelle Jabczynski, director of compliance and strategy at Infinity Rehab, said.

With average length of stays around 25 days, there simply aren’t that many days that providers will have to deal with the lower reimbursements, according to JoLynn Munro, division president at the Wilsonville, Ore.-based Infinity. That said, Munro, Jabczynski, and the team realized that there’s still a strong incentive to prove their worth to partners who may look at that number and see cash-flow headaches.

“What we’ve done to position ourselves is really look at how to deliver care that’s efficient — measuring that efficiency of care delivery over time, or by labor hour, to really demonstrate the value of therapy,” Munro said.

For Infinity, a subsidiary of senior housing and care provider Avamere Family of Companies, that has meant developing dedicated physical and occupational care pathways for specific resident conditions, which individual therapists can then tailor to each person’s needs.

“The way I look at PDPM: That’s just another flavor of value-based purchasing, in that it’s going to present an opportunity for physical therapists to really individualize the care they’re providing within these pathways,” Avamere executive vice president Mike Billings said.



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