Medicare Changes

What Changes Will Medicare Reimbursement Restructure Bring to Therapy?


Evolution of patterns likely


Experts have claimed repeatedly that the coming changes to Medicare reimbursement will not change the extent or nature of therapy available to skilled nursing patients. But an increasing number of authorities are advising that it would be foolish to ignore the likelihood that therapy itself will evolve accordingly.


Skilled Nursing News reported that a recent webinar from Health Dimensions Group of Minneapolis covered that very topic extensively, stressing the need to connect any changes to patient outcomes and clinical needs.


The Centers for Medicare & Medicaid Services (CMS) will be monitoring therapy and rehabilitation levels under the new Patient-Driven Payment Model (PDPM), which will replace the existing Resource Utilization Group (RUG) system on October 1.


The agency has emphasized the focus on therapy levels and patient population even before the launch occurs.


As rehab shifts from a revenue generator to a cost, the emphasis changes from worrying about too much therapy provided to not enough being made available. “We do plan on monitoring that and seeing how much of a change occurs, along with changes in the patient population,” a CMS spokesman said at the time.


In all, despite the reassurances of CMS, it’s unrealistic to think changes in the therapy system won’t occur with PDPM. The webinar by Health Dimensions Group focused specifically on the importance of thorough documentation of patient conditions for physical and occupational therapies as well as speech and language pathology (SLP). One hypothetical 72-hour case for SLP saw the case-mix rate more than quadruple as a result of an additional comorbidity.


SOURCE: Health Dimensions Group, Skilled Nursing News

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