Staff Investment a ‘Make or Break’ as Therapy Providers Weather Medicare Cuts


Therapy providers within the expert nursing space have been forced to adapt.

The sector has already seen a hindrance in access to care following cuts made earlier this yr to the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule (PFS).

Specifically, Medicare Part B physical and occupational therapy rates took a 15% hit in reimbursement for services provided “in whole or partially” by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).

And the recent reductions in reimbursement turn out to be tougher when factoring in the most recent CMS proposed rule for expert nursing facilities — which incorporates a 4.6% cut related to the Patient-Driven Payment Model (PDPM).

Despite the present storms being weathered by therapy providers, and future troubles expected as Covid-19 federal funding and public health emergency-related waivers are phased out, there are some levers a provider could pull — but they’ll come at a value.

That’s based on Mark Besch, senior specialist for presidency affairs and analytics at Aegis Therapies, and Bot Zantua, director of rehabilitation operations at Westminster Communities of Florida.

He and Zantua spoke about how therapy providers can find the correct balance between access to care, balancing the budget and keeping staff completely satisfied in the course of the current labor crunch.

And that balance can’t be struck without making significant investments into the staff, Zantua added.

“We’ve to take a position in our people. Our individuals are our lifeline, it should make or break you,” she said during Expert Nursing News’ recent Clinical Executive Conference in Chicago. “It is rather critical that if you’ve got excellent people, if you happen to develop them with compliance, education, you should have the outcomes you’re searching for. Clinical excellence drives operation and it can’t be the opposite way around.”

Cutting services not an option

Even with federal reimbursement rates for therapy services having been reduced by almost 30% overall, cuts to service usually are not an option for Zantua.

As an alternative, it’s about planning ahead and strategically analyzing data to make the perfect informed decisions for patients. Westminster has actually grown and enhanced its therapy services during this time period, based on Zantua.

Westminster is a life plan community that gives independent living, assisted living, nursing care and rehabilitation and therapy services. Its therapy service offerings include physical therapy, occupational therapy and speech therapy.

The “devil is in the main points” relating to the potential impact of the cuts — including where that provider is positioned on the map, Besch said.

“For those who’re a provider that largely relies on assistants, which frankly many smaller rural providers do, then your impact goes to be greater. For those who’re a bigger provider and you possibly can have a mixture of therapists, then there could also be some options,” he said, referring specifically to the 15% cut to therapy assistants.

There are some strategies which will lessen the impact of the cuts for providers, but there will probably be costs and advantages related to doing so.

A provider could attempt to avoid being financially impacted by the therapy assistant cut all together and deliver all physical and occupational therapy by a registered therapist.

But that task is less complicated said than done given the present industry-wide staffing crisis, and the increased cost related to paying registered therapists to supply the care in the event that they can be found for hire, Besch said.

The scheduling of therapists and therapy staff also can turn out to be more purposeful, albeit more complex, to assist avoid having assistants treating patients from payers who’re going to pay less for that service, he added.

Ultimately, Besch believes now will not be the time to be making cuts to an industry that continues to get well from the Covid-19 pandemic.

“There’s still a variety of recovery that has to occur. Staffing shortages are today as bad as they’ve ever been in my experience. I’m unsure if 2023 will probably be an entire lot higher. So I believe advocacy is critical,” he said in the course of the panel discussion.

Therapy as a ‘cost center’ and the long run of PDPM

PDPM was specifically designed to reimburse expert nursing facilities based on the acuity of the patients they treat, moderately than by how much time the patients spend in therapy.

In consequence, therapy services are seen by some within the sector as a “cost center.”

Nobody can deny that therapy is a value, Zantua said, but she pushed back on the concept that the service doesn’t provide revenue.

“We’re a value I get it — that’s the truth of it. But we’re also bringing revenues. That’s the underside line … There’s a variety of ways to reinforce revenue. But again, it needs to be clinically driven. Once you do it the opposite way around, you’re gonna fail,” she said.

Besch, who echoed Zantua’s thoughts, also said the service stays “as critical today because it’s ever been.”

“Yes it’s a value center and no revenue will not be directly related to therapy prefer it was under RUGS. But have the expectations of your patients modified? I’d suggest not. Is all this therapy really price it? We’ve the information that claims absolutely it’s,” he added.

As PDPM approaches its three yr anniversary in October, Besch believes the relatively recent payment system’s days might be numbered.

When asked by SNN whether PDPM can be around in the following decade, Besch said, “10 years could be a bit of long,” as he believes there’s “constructing momentum” for a unified post-acute payment system.

He said that he would love to see a reimbursement vehicle designed around quality and outcomes.

“I believe that it’s our obligation to deliver the very best, simplest services and interventions that we are able to and people who do needs to be rewarded,” Besch added.


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