PDGM - Therapy

7/18/2019

PDGM - Therapy

7/15/2019

Cindy Krafft Owner/Founder | Kornetti & Krafft Health Care Solutions

Karen Vance Senior Managing Consultant | BKD

? 2019 National Association for Home Care & Hospice

Continuing Education

The planners and presenters of this activity disclose no relevant relationships with any commercial entity pertaining to the content.

? Nurse attendees may earn a maximum of 15.5 contact hours ? Accountant attendees can earn up to 18.9 CPEs

Accreditation Statement

NAHC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

NAHC is [also] approved by the California Board of Registered Nursing, provider #10810.

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Commercial Support provided by Brightree, Excel Health Group, Healthcare Provider Solutions, and Simione Healthcare Consultants.

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7/18/2019

Learning Outcomes

? Understand the myths and the history contributing to current therapy utilization to stop the pendulum swing

? Know what to expect and where to access information for therapy `best practice'

? Use collaboration for most accurate OASIS data

? Shift therapy practice from volume to value

? 2019 National Association for Home Care & Hospice

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PDGM Therapy Utilization Myths

? "Medicare is no longer paying for therapy"

? "Therapists should no longer treat. Focus on teaching and no more than 3 visits"

? "This is the death knell for therapy in home health"

? What do you anticipate the impact will be at your agency?

? 2019 National Association for Home Care & Hospice

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NAHC Survey Results

485 Responses

How do you anticipate PDGM will impact therapy utilization in your agency?

2% 16%

34%

23%

25%

Stay the same Decrease more than 10% Decrease less than 10% Unsure Increase

? 2019 National Association for Home Care & Hospice

What aDbooeustCthMerSaSpayy??

PPS 2019 Final Rule

? We disagree that the PDGM diminishes or devalues the clinical importance of therapy. The musculoskeletal and neurological rehabilitation groups under the PDGM recognize the unique needs of patients with musculoskeletal or neurological conditions who require therapy as the primary reason for home health services.

? For the other clinical groups, we note that the 30-day base payment amount includes therapy services, even if the primary reason for home health is not for the provision of therapy. The functional impairment level adjustment in conjunction with the other casemix adjusters under the PDGM, aligns payment with the costs of providing services, including therapy.

? 2019 National Association for Home Care & Hospice

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Therapy Track Record

Pre PPS

? Low Therapy Use Overall

? < 10

Initial PPS

? Therapy Use Increases

? 10 - 13

Revised PPS

? Therapy Use Increases

? 14+ / 20+

Significant change in PDGM = Confirmation

? 2019 National Association for Home Care & Hospice

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Stop the Pendulum Swing

Pre PPS low therapy utilization

Current PPS high therapy utilization

Appropriate Therapy Utilization

? 2019 National Association for Home Care & Hospice

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Defining "Best Practice"

? APTA Guide to Practice ? Guidelines for the Provision of

Physical Therapy in the Home

? AOTA Occupational Therapy Practice Guidelines

? Home Health: A Guide for Occupational Therapy Practice

? ASHA Scope of Practice in Speech- Language Pathology

? ASHA Practice Policy

? 2019 National Association for Home Care & Hospice

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Decision Making Today

Therapy frequency and duration in your agency currently is based on (select all that apply)

Unsure 8

Office Based Care Coordination Recommendations

Evidenced Based Clinical Pathways

120 188

Therapist?Clinical Decision Making

422

Therapy Thresholds

53

Functional Score from OASIS

239

0 50 100 150 200 250 300 350 400 450

? 2019 National Association for Home Care & Hospice

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Decision Making in PDGM

Therapy frequency and duration in your agency in PDGM will be based on (select

all that apply):

Unsure

56

Office Based Care Coordination Recommendations

Evidence Based Clinical Pathways

194 224

Therapist Clinical Decision Making

335

Clinical Grouping

154

Functional Grouping

225

0 50 100 150 200 250 300 350 400

? 2019 National Association for Home Care & Hospice

Functional OASIS Items

PPS

PDGM

M1800: Grooming

No

Yes

M1810: Current ability to dress upper

Yes

Yes

M1820: Current ability to dress lower

Yes

Yes

M1830: Bathing M1840: Toilet Transferring M1850: Transferring M1860: Ambulation/Locomotion M1033: Risk of Hospitalization

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

? 2019 National Association for Home Care & Hospice

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OASIS Collaboration

485 Responses

How do you anticipate PDGM will impact how therapist and nurses

collaborate on OASIS data collection?

5%2% 16%

77%

Increase use of structured processes Unsure

We do not use structured processes Decrease use of structured processes

? 2019 National Association for Home Care & Hospice

Reconciling M and GG

? 2019 National Association for Home Care & Hospice

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