COVID-19 pandemic leaves questions on results of Medicare reimbursement restructuring in SNFs

Just a few months after CMS massively modified how expert nursing amenities are reimbursed for remedy companies, the pandemic hit and threw long-term care operations right into a tailspin.

That makes it troublesome to find out precisely how the change affected remedy companies and therapists in nursing houses, researchers say.

A report printed in Well being Affairs on Monday exhibits that therapist staffing ranges had been lower in anticipation of and after the change to the patient-driven cost mannequin in October 2019. The brand new mannequin changed the long-standing Useful resource Utilization Group cost system, often known as RUG, with basic assist from the post-acute care trade. However, after the fourth quarter of 2019, there is not dependable knowledge to additional observe the adjustments, the authors stated.

As COVID-19 unfold throughout the U.S., nursing houses had been now not required to report payroll-based knowledge, leaving unknowns on the long-term results of the PDPM transition on staffing ranges.

In comparison with July and August, staffing ranges of bodily therapists fell 5.5%, bodily therapist assistants dropped 9.4%, occupational therapists decreased 6.1%, occupational remedy assistants fell 10.2% and speech-language pathologists slipped 4.3% throughout September by way of December 2019, in accordance with the report. These cuts had been “virtually completely” to contract workers.

Contract workers represented 100% of the cuts to bodily therapists, 92% for bodily remedy assistants, 100% for occupational therapists, 93% for occupational remedy assistants and 133% for speech-language pathologists, the report discovered.

When PDPM was first applied, Genesis Healthcare, a nationwide chain supplier, stated 585 of its 10,000 rehabilitation workers had been affected by the cost mannequin change.

The American Bodily Remedy Affiliation stated that “Previous to the pandemic, the implementation of PDPM had an affect on some therapists and therapist assistants’ hours in SNFs. Primarily based upon perceived wants following PDPM implementation, in addition to in the course of the pandemic, it’s possible that some suppliers decreased hours of therapists and therapist assistants whereas different suppliers didn’t.”

Regardless of therapist cuts, there have been restricted staffing will increase throughout different positions; there weren’t any good points for occupational therapist aides, registered nurses or licensed sensible nurses. There was a 3.2% improve in bodily remedy aides and 0.4% improve in licensed nursing assistants.

The earlier Medicare reimbursement mannequin lined as much as 720 minutes of remedy for every affected person per week, which critics say incentivized extra remedy. The PDPM mannequin bases reimbursement on a affected person’s situation and what care is required. It additionally relaxed among the guidelines round group remedy, permitting as much as 25% of a affected person’s remedy to be in group periods. The report discovered that group remedy periods elevated after the PDPM transition, possible changing extra one-on-one remedy periods.

“It’s unclear, nonetheless, whether or not reductions signify a “right-sizing” of remedy departments that had been beforehand designed to ship financially motivated remedy of restricted medical profit or a type of skimping that limits sufferers’ entry to wanted rehabilitation companies,” the authors wrote.

The American Bodily Remedy Affiliation stated group and concurrent remedy largely stopped in the course of the pandemic, making it troublesome to inform whether or not the kind of remedy being provided has modified, both from PDPM or the pandemic.

“After the general public well being emergency concludes, we might even see the resurgence of group and/or concurrent remedy,” the affiliation stated.

Brian McGarry, assistant professor within the division of geriatrics and getting older on the College of Rochester’s Division of Drugs and one of many report’s authors, stated the report solely provides “one snapshot of PDPM round staffing.”

“We all know some amenities shed remedy workers in response to PDPM. What we do not know is what does that imply for sufferers, how does that change the quantity of remedy delivered,” McGarry stated.

The American Well being Care Affiliation and the Nationwide Heart for Assisted Dwelling, which represents greater than 14,000 long-term care amenities, couldn’t be reached for remark.

McGarry stated patient-level knowledge that breaks down how remedy was delivered was simply launched, which is able to give researchers some perception into how affected person care modified within the first few months of PDPM.

“With COVID, the information on PDPM adjustments might be arduous to find out,” a spokesperson for the American Bodily Remedy Affiliation stated.

PDPM was meant to be price range impartial however cuts to workers with out corresponding will increase in different staffing signifies that nursing houses are “in all probability popping out a bit of forward,” McGarry stated, noting that the shortage of hiring might be a “yellow flag” price watching.

“When you’re accruing price financial savings, what are you doing with the cash you are not spending on them anymore?” McGarry stated.

However given how underfunded nursing houses had been discovered to be in the course of the pandemic, “that will not essentially be a foul factor,” McGarry stated. CMS additionally plans to readjust cost charges as wanted.

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