Posted On: July 11, 2019 by NARA in: Group Therapy Payment Reform PDPM Skilled Nursing Facilities SNF Technology
How much group therapy should providers be aiming for when the clock strikes PDPM?
Based on my conversations with our clients, SNFs and therapy providers throughout the country, I’ve heard plans that range from ramping up rapidly, to gradually phasing it in over months or years.
There are good reasons to go in either direction, or anywhere in between.
Consider the financial uncertainty. Many SNFs just don’t know what their books will look like several months into PDPM. Even with rigorous scenario modeling, there are simply too many variables to be able to make a solid prediction.
Compound this with already razor-thin SNF margins, and it’s clear that finding efficiencies needs to be a top priority. Group therapy makes sense as a response.
But any decision to implement group therapy needs to be considered in light of how it would look to all the stakeholders, including staff, patients, loved ones, as well as auditors, such as CMS, DOJ and OIG.
Discussions at the NARA Spring Conference highlighted a number of risks.
How will CMS respond to changes in therapy practice? Unclear.
What about the risk of audits and litigation? It will increase, according to attorney Glenn Hendrix.
But if we implement group therapy, and outcomes are the same or better, it should be fine, right?
Maybe.
Hendrix cautioned that if provider behavior changes significantly and outcomes stay the same, auditors can actually go back 6-10 years and make a case that too much therapy was provided pre-PDPM.
A presentation by Laura Ellis from the Office of the Inspector General (OIG) also highlighted just how much data is available to scrutinize providers and monitor past claims. As she said, there is “no flying under the radar.”
It puts SNFs in a catch-22: either run into trouble with CMS for not providing enough care post-PDPM, or be in trouble for providing too much care under RUG-IV!
This doesn’t mean that SNFs should put the brakes on plans for group therapy. Indeed, the entire industry is gearing up for it. It only means that whatever we do, we do with our eyes wide open.
Outcomes with group therapy need to be the same or better, but that’s not enough. Providers also need to explain why they are implementing group therapy now, and not 5 years ago.
If group therapy is going to get the buy-in it deserves from front-line therapy staff, CMS, DOJ, and other stakeholders, it needs to be presented as a natural advance in the way we deliver care. With the knowledge, clinical evidence and technology we now have, it should actually be a natural advance!
To answer the question of “why now” for group therapy, providers can leverage the very thing that made our entire healthcare system possible… new knowledge, innovation and progress.
Innovative technologies and solution providers are only now coming out with brand new approaches to help therapy providers train staff, share information, and implement group programs.
At Jintronix, our top priority ahead of PDPM is to create structured, engaging group therapy programs. The goal is to make it easy for therapists to run these groups by setting the context, making it fun, making it social, and keeping it focused on functional goals.
There is a wide open space of new ideas to design, develop, test, and improve on. For Jintronix and the entire SNF industry, now is the time to take on this challenge and leave no stone unturned!
Contact Info:
Mark Evin – CEO, Jintronix
mark@jintronix.com
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