Contract Therapy Cuts Therapist Jobs Post PDPM

A new study published in the journal Health Affairs shows that therapist staffing coverage in nursing homes fell up to 10% in the 4th quarter of 2019 compared to the same quarter in the previous two years. Why is that significant? The 4th quarter of 2019 was the first quarter following the implementation of PDPM, the new Medicare payment model in the skilled nursing industry. The PDPM payment model eliminates the amount of therapy minutes delivered as the determining factor in reimbursement. The study states that these cuts primarily came from contracted therapists, not those employed by the nursing home itself.

The coronavirus pandemic which disrupted our industry in March of 2020, affected the ability to continue to study therapist staffing levels. This was due to all of the industries focus being rightly placed on how to handle this pandemic. However, even this one quarter of data is important and should cause skilled nursing facilities to take look at their contract providers staffing levels. Less therapists in your building might not necessarily be cause for alarm but it is important to examine this because less therapists could mean less care for your residents and potentially poorer clinical outcomes.  There is also a regulatory compliance risk to providing significantly less therapy, specifically if patient outcomes are negatively affected. This is something CMS will be looking at in the future when assessing the PDPM change.

The things you would want to look for with your contact provider are:

  1. Are they not providing care based needs but instead on reimbursement levels resulting in decreased treatment time with your residents, specifically on those residents whose insurance reimburses using PDPM? Is every patient receiving 30 min treatments or less?
  2. Are all patients automatically getting group and concurrent treatments without consideration for if this treatment is beneficial to the patient? COVID has severely limited these types of treatments, but they will be coming back eventually, and you would want to know if they are being used appropriately.
  3. Does my contract therapy company have the staff to meet the needs of my long term care residents as well as my skilled residents?
  4. How do my residents feel about the therapy they are getting? Are they happy with therapy or do they have complaints? What are their complaints? Are they seeing consistent therapists or is it someone new every day? Do they feel they are getting the appropriate amount of therapy?

While more data will be obtained about this topic as we rebound from the effects of the coronavirus, the data that this study does provide should cause skilled nursing facilities to investigate and ask questions of their contract therapy companies to ensure they are meeting the needs of their residents.