Re: How Medicare Rewards Copious Nursing-Home Therapy
The challenges to ensuring delivery of appropriate patient care against systems that incentivize volume-based rehabilitation services are, unfortunately, well known to those in the rehabilitation profession ("Calculated Care: Nursing-Home Rehab Raises Medicare's Tab," page one, Aug. 17).
It isn't uncommon for rehabilitation professionals to find themselves in practice situations in which they are pressured to meet goals that have less to do with the patient’s needs and more to do with the volume of services provided. When we override clinical judgment in order to meet inappropriate productivity goals, we are putting patients at potential risk, and our licenses on the line.
Patient care decisions should be made by clinicians in accordance with their clinical judgment and ultimate professional responsibility to their patients. Value—the outcome of care relative to the cost or resources needed to provide that care—should be the primary indicator of performance.
The American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA), have been in dialog with industry to address the issue of volume-based versus value-based care and to improve compliance. Ethical service delivery and clinical integrity are priorities. Our goal is to help clinicians navigate complex regulation and payment systems, emphasize their responsibility to report unethical care provision, and promote value-based patient care.
I speak for my colleagues Virginia C. Stoffel, PhD, OT, BCMH, FAOTA, president of AOTA, and Judith L. Page, PhD, CCC-SLP, president of ASHA, in ensuring the public that we are deeply committed to ensuring that the correct incentives are invoked in care delivery, in a manner that earns our patients' trust.
Sharon L. Dunn, PT, PhD, OCS
American Physical Therapy Association
Virginia C. Stoffel, PhD, OT, BCMH, FAOTA
American Occupational Therapy Association
Judith L. Page, PhD, CCC-SLP
The American Speech-Language-Hearing Association