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Examining Therapy Utilization and Quality of Care at Skilled Nursing Facilities Under Patient Driven Payment Model
According to a recent publication, the use of the Patient Driven Payment Model (PDPM) in skilled nursing facilities (SNFs) resulted in a considerable decrease in individual occupational therapy (OT) and physical therapy (PT) utilization and a smaller increase in group OT and PT utilization (J Am Med Dir Assoc. 2022;S1525-8610(22)00431-5. doi:10.1016/j.jamda.2022.06.003).
“The PDPM was implemented in October 2019 to reimburse skilled nursing facilities (SNFs) based on Medicare patients’ clinical and functional characteristics rather than the volume of services provided,” wrote, Wei Zhang, MD, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon and colleagues.
The objective of the study was to investigate the changes in therapy utilization and quality of care under PDPM. The study was a Quasi-experimental design that included in total, 35,540 short stays by 27,967 unique patients in 121 Oregon SNFs.
Researchers utilized the Minimum Data Set data from January 2019 to February 2020 and compared therapy utilization and quality of care for Medicare short stays before and after PDPM implementation to non-Medicare short stays.
Results revealed that the number of minutes of individual OT and PT per week for Medicare stays diminished by 19.3% (P < .001) and 19.0% (P < .001), respectively, in the first 5 months of PDPM implementation (before the COVID-19 pandemic).
The number of group OT and PT minutes expanded by 1.67 (P < .001) and 1.77 (P < .001) minutes, respectively, and the significance of PDPM effects differed extensively across stays with different diagnoses. The implementation of PDPM was not linked with statistically substantial changes in length of SNF stay (P = .549), discharge to the community (P = .208), or readmission to the SNF within 30 days (P = .684).
“SNFs responded to PDPM with a significant reduction in individual OT and PT utilization and a smaller increase in group OT and PT utilization,” concluded Dr Zheng and colleagues, adding, “No changes were observed in length of SNF stay, rates of discharge to the community, or readmission to the SNF in the first 5 months of PDPM implementation.”
