Survey Studies Provider Utilization of Therapy Services Under PDGM

Birmingham, Alabama (June 7, 2019)—About a third of providers don’t expect the Patient-Driven Groupings Model (PDGM) to change their therapy utilization, according to a survey conducted by the National Association for Home Care & Hospice (NAHC) recently concluded a survey of the home health industry on the subject; another quarter of respondents to the survey said they expect a decrease of 10% or more.

In a change from the current prospective payment system, with a goal of providing value-based care, PDGM does not weight therapy visits toward reimbursement. Therapy services can include physical therapy, occupational therapy and speech therapy, among others. While providers will be reimbursed at a lower rate or not at all for therapy visits, they are still expected to provide therapy to patients who need it.

The results of NAHC’s survey were presented in a webinar hosted by Cindy Krafft, PT, MS, owner and founder of Kornetti & Krafft Health Care Solutions and NAHC President William A. Dombi. The survey had a total of 685 respondents with 487 taking the full survey. Each state had at least one respondent. Providers were either freestanding (40%), institution-based (9%), health system affiliated (25%), or government-based (4%).

Fifty percent of providers do not anticipate making staff changes in therapy. Twenty-eight percent anticipate decreasing staff.

A total of 422 providers reported that current therapy frequency and durations decisions are based on decisions made by therapy and clinical staff. Some 335 providers reported this would remain the same under PDGM.

Seventy-seven percent of providers anticipate an increase in the use of structured processes to facilitate therapy and nursing staff collaboration on OASIS data collection. Only 2% anticipate a decrease in the use of these services.

Providers reported their top strategies for coping with PDGM, including improved case management, rebalancing the patient mix, focusing on coding accuracy, increased use of PTAs, and staff education. Another top strategy was to continue with current practices under PDGM.

Providers should remain wary of Home Health Compare scores and STAR Ratings, as well as the risk for malpractice lawsuits before making major changes to their therapy programs, the presenters said.

Find the full presentation here and view the webinar here.