PAC/PDPM - Evaluating Rehabilitation Programs in a Patient Driven Payment Model World

CMS fundamentally changed how SNFs must operate through the implementation of the patient driven payment model (PDPM) on October 1, 2019. With the PDPM, CMS aims “to better ensure that resident care decisions appropriately reflect each resident’s actual care needs” by removing “to the extent possible, service-based metrics from the SNF PPS and [deriving] payment from verifiable resident characteristics.” CMS views the PDPM as part of its broader shift from volume to value. The overwhelming concern from the therapy community and rehabilitation advocates was the amount of therapy provided in these settings will be significantly reduced in an effort to reduce costs, and as a result, the quality of care delivered to beneficiaries will suffer. Like any payment system, the PDPM relies on providers to provide the right care at the right intensity for the condition(s) the patient presents with. This session will discuss strategies providers have used to retool therapy programs under the PDPM by focusing on achieving similar or better outcomes. Specifically, the strategies of high-intensity exercise training (HIET) and utilization of group and concurrent therapy will be explored.