APTA, AOTA, and ASHA say systems are being improperly used in skilled nursing facilities
The American Physical Therapy Association (APTA) recently joined with the American Occupational Therapy Association (AOTA) and the American Speech-Language-Hearing Association (ASHA) in releasing joint letters and a consumer “fact sheet” exposing inappropriate behaviors by SNFs and HHAs.
The letter pertained to enforcement of new Patient-Driven Payment Model (PDPM) and Patient-Driven Grouping Model (PDGM) systems to reduce patient care, cut therapist hours, and sometimes eliminate entire jobs.
In a joint statement announcing release of the letters, the organizations write that “Preserving access to therapy services is critical, particularly as postacute care organizations prepare for the expected surge in patients recovering from COVID-19.”
The consumer-focused letter, sent to numerous patient and consumer advocacy groups, cites examples of HHAs and SNFs reducing therapist hours, requiring therapists to perform services outside their scopes of practice, ignoring or modifying physician orders and plans of care, misinforming therapists about which treatments are allowed under the payment systems, and failing to provide maintenance therapy, among other practices.
“Our associations stand committed to ensuring all patients retain access to medically necessary therapy services and ensuring all stakeholders understand the impact these business-driven decisions can have on patient outcomes,” the organizations write, adding that “Medicare beneficiaries and their caregivers deserve to know the facts about Medicare coverage in SNFs and HHAs to address the inappropriate practices.”
To that end, APTA, AOTA, and ASHA created an accompanying fact sheet that explains, in easy-to-understand language, the most common mistruths patients and caregivers are being told. Among the messages that the organizations point out as false:
- Medicare limits the amount of therapy that can be received.
- Medicare dictates what forms of therapy a therapist can deliver.
- A portion of SNF therapy treatment must be provided in a group setting.
- Medicare only pays for therapy services that improve a patient’s condition.
- Medicare does not pay for certain diagnoses.
- Medicare does not cover home health services unless the patient is discharged from the hospital or institutional setting.
- Medicare won’t reimburse for any home health care services that exceed a total of 30 days of service.
“Many SNFs and HHAs are using these payment systems in ways that support patient access to necessary care, but some are purposefully providing misinformation,” said Kara Gainer, APTA’s director of regulatory affairs. “We believe the facilities and agencies misusing the systems are outliers, but it’s still important that all patients are aware of their rights.”
The fact sheet includes steps patients can take if they believe a SNF or HHA has inappropriately restricted access to therapy services, including links to consumer advocacy groups that can help pursue the issue.