Home Health & Hospice Week

Providers also plan to drop therapists — both contract and directly employed.

The elimination of therapy as a case mix factor under the Patient-Driven Groupings Model is a game changer. How your peers plan to cope with the drastic difference may inform your own PDGM ramp-up strategy.

The National Association for Home Care & Hospice surveyed industry members about their plans for therapy under PDGM. The survey drew 685 respondents across all 50 states, the trade group said in a June 4 webinar about the results.

According to the survey, nearly half (48 percent) of respondents expect to decrease therapy utilization under PDGM. Those expecting the decrease were nearly evenly divided on expecting decreases of more than 10 percent versus less than 10 percent.

And more than half (58 percent) of respondents expect to decrease contract therapy staffing under PDGM, the survey found. The majority of those expecting that decrease forecast that it would be a drop of greater than 10 percent. And 26 percent of survey respondents expect to pay less for therapy services under contract.

On the other hand: Half of respondents expect to keep their direct therapy staffing at the same level under PDGM. But 28 percent expect employed staff levels to drop under the new payment model.

Therapy Utilization Control To Centralize

Survey responses indicate that the basis for therapy utilization will undergo change under PDGM as well. Currently, therapist clinical decision making is by far the most popular basis for therapy frequency and duration. Under PDGM, survey respondents expecting that to be the basis fall by nearly 21 percent.

In contrast: Office-based care coordination recommendations and evidence-based clinical pathways are expected to become more popular reasons for determining frequency and duration — by 62 percent and 19 percent, respectively.

Procedures surrounding OASIS are also expected to see a drastic change, the survey indicates. A whopping 77 percent of respondents plan to increase use of “structured processes” for having therapists and nurses collaborate on OASIS data collection.

Plus: About 25 percent of respondents expect to increase use of remote patient monitoring/telehealth under PDGM, the survey says.

The survey shows that HHAs plan to undertake a number of steps — some of them drastic — to prepare for PDGM’s therapy change. But providers shouldn’t make kneejerk reactions, NAHC cautions.

Under the payment model, the Centers for Medicare & Medicaid Services will redistribute case mix weights to other categories, the webinar presenters pointed out. Balanced case mix means that PDGM “should result in comparable aggregate revenues.”

Keep in mind: “Therapy related episodes may still bring profit,” the webinar stressed.

Note: See the webinar slides, including a breakdown of responses by ownership type and size, at www.nahc.org/wp-content/uploads/2019/06/WebEvent_19-06-04-1200_Handout.pdf.