Therapy Utilization Declines in SNFs Under Medicare’s Patient Driven Payment Model

The Patient Driven Payment Model (PDPM) was implemented into skilled nursing facilities (SNFs) in October 2019 to reimburse SNFs based on Medicare patients’ clinical and functional characteristics as opposed to the volume of services provided. This led researchers to assess quality of care and changes in therapy utilization under the model.

“SNFs responded to PDPM with a significant reduction in individual occupational therapy (OT) and physical therapy (PT) utilization and a smaller increase in group OT and PT utilization,” wrote study authors.

The study included 35,540 short stays by 27,967 unique patients in 121 SNFs in Oregon. Minimum Data Set data was extracted between January 2019 and February 2020. Therapy utilization and quality of care was compared for Medicare and non-Medicare short stays after the PDPM implementation.

Researchers determined in the first 5 months of PDPM implementation, the number of minutes of individual OT per week for Medicare stays decreased by 19.3% (P < .001) and decreased by 19.0% (P < .001) for PT.

Group OT and PT minutes increased by 1.67 (P < .001) and 1.77 (P < .001), but the magnitude of PDPM effects varied across stays with different diagnoses.

Statistically significant changes in length of SNF stay (P = .549), discharge to the community (P = .208), or readmission to the SNF within 30 days (P = .684) were not connected to the PDPM implementation.

“Further research should examine the relative effects of individual and group therapy and their impact on the quality of SNF care,” concluded researchers.

Reference:
Zhang W, Luck J, Patil V, Mendez-Luck, CA, Kaiser A. Changes in therapy utilization at skilled nursing facilities under Medicare’s patient driven payment model. J Am Med Dir Assoc. Published online July 7, 2022. doi:10.1016/j.jamda.2022.06.003