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  • APTA: New SNF Payment System Should Drive Quality Patient Care, Not Staff Layoffs

    Fewer than 48 hours after the launch of a new Medicare payment system for skilled nursing facilities (SNFs), APTA began receiving word from physical therapists (PTs) and physical therapist assistants (PTAs) that a number of providers were announcing layoffs or shifts to PRN roles with reduced hours and fewer or no benefits. Many were told by their employers that the new system, known as the Patient-Driven Payment Model, or PDPM, was the reason for reduced staffing levels and less therapy.

    There's one problem with that explanation: it isn't true.

    That's the message APTA is delivering to SNFs, association members, and the media as it works to debunk myths surrounding a system that was designed to support clinician decision-making and push SNFs toward a more patient-focused payment model.

    "Yes, this is a new payment system, but it doesn’t change the reality that staffing and service delivery must continue to be grounded in quality patient care," said Kara Gainer, APTA's director of regulatory affairs.

    What PDPM changes—and what it doesn't
    The US Center for Medicare and Medicaid Services (CMS) describes the PDPM as an attempt at "better aligning payment rates…with the costs of providing care and increasing transparency so that patients are able to make informed choices." In that sense, PDPM is another step in the overall evolution of health care toward a more outcome-based, patient-focused system. And it didn’t arrive out of nowhere: CMS has been floating proposals for revamping SNF payment since at least 2017.

    Still, the new system, with its basis on classifying SNF residents among 5 components (including physical therapy) that are case-mix adjusted and employing a per diem system that can be adjusted during a patient's stay, marks a big change for SNFs. For SNFs that embraced volume-based approaches to care, the shift is even more significant.

    That may be true, Gainer said, but some of the most important elements of PDPM are the things that haven't changed under the new system.

    "Absolutely nothing changed between September 30 and October 1 [the startup date of PDPM] about patient needs in SNFs, or the value of physical therapy in meeting those needs," Gainer said. "PDPM is predicated on the idea that rehabilitation professionals will exercise clinical judgment and furnish reasonable and necessary services to patients."

    APTA created a 1-page handout that summarizes what's different about the PDPM—more patient focus, reduced administrative burden, a new definition of group therapy and a 25% combined limit on group and concurrent therapy, and a new way to determine function scores—but the resource also points out what remains unchanged: medically necessary care as a baseline standard, the criteria for skilled therapy coverage, and the centrality of clinical judgment, among other elements. Additionally, the need for daily skilled nursing services or rehabilitation services has not changed.

    The bottom line, according to Gainer, is that decisions that override clinical judgment and reduce or compromise patient care shouldn't be attributed to any requirements contained in PDPM.

    "Assertions that the PDPM mandates cuts in care are untrue, as are claims that PDPM requires the maximum use of group or concurrent therapy, sets out productivity requirements, and dictates how many minutes of care therapists can provide based on payment categories," Gainer said. "Whether deliberate or simply a misinterpretation of the rule, these myths need to be put to rest."

    A big incentive for SNFs to get past the myths: CMS is paying attention
    As APTA members began sharing their stories of layoffs and status shifts attributed to PDPM, APTA President Sharon Dunn, PT, PhD, took to Twitter with a simple message:

    "PDPM changed Medicare payment methodology for SNFs on Oct 1. It did not change the value of physical therapy services or patient needs. Reducing PT and PTA staff 46 hours into this model reflects poorly on the commitment to patient access and quality of care. And CMS is watching."

    SNFs should pay particular attention to the last sentence of Dunn's tweet, Gainer said.

    "Anyone who's followed CMS rulemaking over the past few years knows that patient outcomes data and their link to plans of care are becoming extremely important in how CMS shapes payment and other rules—and rightly so," Gainer said. "CMS has already indicated to us that they are closely monitoring the actions of health care facilities post-PDPM to determine if patient needs are driving decision-making, and may propose changes to counter any trends that impede the overall goals of the system."

    In an interview for an article on PDPM published in Skilled Nursing News, Robert Lane, a consulting director for health care consulting firm BKD, called the SNF layoffs and adjustments "premature," and stated his surprise that the SNFs didn't "pump the brakes a little for 90 days to see where we're at after the first quarter, couple of billing cycles."

    And like Gainer, Lane told Skilled Nursing News that it's certain the sudden drastic changes will "draw attention from CMS."

    APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association have issued a joint statement noting that they have shared reports of layoffs directly with CMS and will continue to keep the agency abreast of reductions that put patients at risk.

    APTA's continued work
    The first versions of what evolved into PDPM emerged in spring of 2017, and APTA immediately began advocating to CMS on behalf of patients and the physical therapy profession. The association's efforts, fueled by member engagement, led to some significant changes to the final rule—including CMS' decision to implement a combined limit of 25% of group and concurrent therapy.

    But now, with PDPM in place, APTA's efforts need to shift to careful monitoring of how the rule is being interpreted and implemented, and its impacts on patient care and the PTs and PTAs providing that care. The reason is simple, according to Gainer: rules can be changed.

    "Another myth that's being circulated is that the PDPM is now written in stone and that no adjustments can be made," Gainer said. "That has never been the case with rules from CMS, and certainly isn't the case with this system—especially given the amount of attention CMS will be paying to how SNFs interpret and implement PDPM, and the degree to which those changes impact patient access to medically necessary care."

    Get the facts on PDPM and stay up-to-date on news about the new system: visit APTA's Skilled Nursing Facility and Home Health Payment Models webpage. Do you have your own story about how the PDPM has affected your work? Contact advocacy@apta.org.


    • Despite APTA and CMS efforts, multiple therapists (PT, OT, and SLP) lost their jobs last week in Reno, NV, both SNF and Home Health. And many others are worried more cuts are to come.

      Posted by Grant Glass, PT, CIMT, OCS, CAFS, GPS, 3DMAPS, Cer on 10/9/2019 5:19 PM

    • I smile chuckle every time I see "CMS is Watching" in SNF and Home Health. When there is dollar signs in their eyes they don't care who is watching. We should be focused on direct access to services and acting like we are worth it. Speak Up!

      Posted by Joe Whitehurst on 10/9/2019 5:23 PM

    • has CMS released a comment in response to the layoffs and productivity demands by SNFs?

      Posted by allison bush on 10/9/2019 5:45 PM

    • Hi, my name is Jason Callaghan and I'm a physical therapist who works both full-time and part-time as well. I work for a few different companies at six different buildings total. Every single one of the buildings I work for has implemented layoffs. This has been the common theme of all the buildings in reaction to the pdpm model. These are the facts. We are playing what seems to be a giant game of "cops and robbers." The PDPM model IS, like it or not, the indirect cause of the layoffs...which are a disgusting unintended consequence. Not only were there layoffs, but many companies gave no warning as to whom would be getting laid off in order to not allow those workers the ability to use their remaining PTO!!! As I talk more with my fellow PT/OT/SLP and assistants, we are all in uproar. We all feel we need a union, not just an association. We dont get raises unless we quit and renegotiate. We are forced to agree to terms at employment to waive rights such as the right to discuss wages--which allows employers to divide, conquer and underpay new grads or females in particular. We are forced to give 30 days notice before ending employment, yet they do not reciprocate. The list is long and PDPM is one more addition to it. I agree that PDPM is not directly to blame but it is DEFINATELY indirectly to blame. I would gladly challenge any of your authors on this. As soon as rehab companies analyzed the new group and concurrent loopholes they could exploit, they cut staff and told me and others to then treat an increased number of patients (increased workload) at a higher productivity rate--which incedentally also decreases our hours worked. As a result, we now have more overworked therapists providing inferior care because of the grouping and concurrent loopholes/rules, with patients and therapist caught in the middle of the CMS and rehab big business tug of war. Again I say WE NEED A UNION. If I knew how to organize and create it, I would. I volunteer to run if needed!

      Posted by Jason J Callahan on 10/9/2019 6:22 PM

    • The fact is that the new payment system IS TO BLAME, because it gave SNF rehab providers a group & concurrent loophole to exploit. Now shareholders and rehab providers can really exploit therapists and provide inferior patient care. I did not get laid off, but saw first hand the massive layoffs in my local area. By the time this cycle corrects, many therapists will have moved on from the profession. I personally know some who already are.

      Posted by Jason Callahan on 10/9/2019 6:36 PM

    • I am a PTA that was laid off Friday October 4. My company said it was downsizing but kept 2 travelers including one that started Monday September 30 to cover a maternity leave.

      Posted by Wendy Kieb on 10/9/2019 6:39 PM

    • Of course PDPM was going to lead to layoffs, and one of the main reasons is only hinted at in this article. "For SNFs that embraced volume-based approaches to care, the shift is even more significant." Let me interpret that. How many of us have helped at a building where administration, or maybe our boss, insisted most of our patients reach the 720 minute level? Or, how many times did we get creative and squeeze out that extra 30 minutes of therapy on someone who was sick or fatigued to reach our RUG level? Ever hear this one? "It's her last day, we need the minutes." We were in a system that paid us more when we provided more, more, more therapy. Has anyone pushed you to get more minutes since October 1st? Of course not. Now we are in a system where Medicare pays the same daily rate whether we give 15 minutes or 72 minutes of therapy. Reducing therapy now means it costs less to care for a patient. Less therapy means less staff. This was totally predictable. PDPM relies on clinicians and administrators to be ethical and deliver the right amount of care to get patients better. What we can hope for is, for places that cut therapy too much, it will show up as declining outcome measures, and additional dollars will only flow to those places that have maintained high quality care.

      Posted by John Johnson on 10/10/2019 1:41 AM

    • With this news, the 8% Medicare cut proposed, and the PTA cut the profession is looking almost unsustainable, especially for the new generation of $100K DEBT DPT kids.

      Posted by Jason on 10/10/2019 9:19 AM

    • We have ethical and moral obligations to report abuses of the system no matter how hard that may be. Get involved. Join the APTA so they can fight for the betterment of patient care and your practice and well-being. Get involved in your local Chapter. I do know that this is easier said than done but if it is not done the story we have to tell will never change.

      Posted by Cori Zook-Arquines on 10/10/2019 9:43 AM

    • Our first PT group was baseball themed, including music and the patients performing “the wave” today we will have an OT group. Today is the primary OTs birthday. She leads the group...and they will be making her a birthday cake! I assigned a COTA a patient as concurrent over the weekend...she text that she wasn’t appropriate for concurrent, so I changed it to individual treatment. Changes can be the opportunity that we make it. It was not that long ago that we heard, on social media, the moans and groans of over utilization. In our last Staff meeting, I asked our therapists to take a big diaphragmatic breath. Part of the weight if skilling appropriate patients for their SNF stay has been lifted off of our shoulders.

      Posted by Charlene Anderson on 10/10/2019 9:57 AM

    • Despite loving SNF patients, this is why I left the SNF world 7 years ago and never looked back. We gave up our professionalism in this setting and let executives/administrators treat us like general laborers rather than the skilled professionals we are. We are the revenue generators. We should hold all the power in a SNF, outpatient clinic, and IRF. Without us, there is no business and every other profession in these settings would be out of a job, even the MDs. Yet, we gave up this power because our professional association has failed to promote this to us and to the companies that employ us. Patient care needs to be medically necessary and fiscally responsible. Fiscally responsible should not mean helping a bunch of executives and administrators who never touch a patient get bigger offices, a new HQ, or quarterly bonuses!

      Posted by Ben Mannisio on 10/10/2019 1:57 PM

    • Obviously Ms Dunn and Gainer are disconnected from what we as working therapists endure on a daily basis. Is the corporations,our employers that do not want to loose profit at the expense of us therapists. How is CMS watching, how are these companies going to be hold accountable. This is never ending saga and is us the working therapiat who continue to get the short end ofnthe stick.

      Posted by Sheila on 10/10/2019 6:42 PM

    • It seems that the PTs and PTAs who have been laid off by skilled nursing facilities in anticipation of the start of the deceptively-named “patient-driven payment model” have been caught between the “profitability” of the SNF industry and Seema Verma’s CMS push to save 2 billion dollars in ten years with an arbitrary limitation of 25% on their expenditures for therapy services to SNF patients. According to those who speak for CMS policy, there is and has been a problem of over-utilization of health care services and financial incentives that have led to payment for “unnecessary therapy”. They use rhetoric to justify their cost reduction decisions with clichés that they are being “patient-focused”, “patient-driven”, “patient-centered” and supporting patients’ treatment plans “best attuned to their individual needs and goals”. What is unfortunate is that our professional associations to a great extent enable the ruse. Furthermore, this idea that the obscenely exorbitant cost of health care services in the United States is due to over-utilization and can be corrected with something called “consumer-driven” health care is wrong. And forcing an individual to make a terribly consequential decision in electing to forgo medical care because of its cost is not “patient-centered” care, it’s cruel.

      Posted by Stephen Small on 10/10/2019 6:50 PM

    • I have seen so many changes in reimbursment in the last 24 yrs of being a PTA. And, I predict the PDPM model will not be the last. This isn't the first time therapists have lost their jobs due to payment changes. If CMS suspects abuse of the system, I garantee there will be more changes, and rightfully so. If there is too many complaints about decreased therapy minutes and an increased push towards concurrent and group treatment sessions, they will change the rules again. It is up to us as clinicians to do what is clinically appropriate to meet the needs of our patients and help them achieve their goals.

      Posted by Michele Dart on 10/10/2019 8:01 PM

    • Does APTA plan to put out a similar statement on behalf of home health therapists when PDGM hits us in January? We have already seen the same staffing layoffs and proposed cuts in pay, visits per episode, and treatment treatment planning. It would be great to have a statement from the APTA to present our employers before it hits.

      Posted by Andrea Barefoot on 10/11/2019 6:53 AM

    • What a shame.... of course there are going to be lay offs, pay cuts, pay cuts in disguise where productivity is increased and no change in pay. In the homecare arena we are about to see mass chaos and the first quarter of 2020 will result in multiple unemployed therapists as a company isn’t going to pay an employee that has no work. One big thank you to CMS for pain and suffering that therapists are about to endure.

      Posted by Trevor Baker, PT, DPT on 10/11/2019 9:28 AM

    • My name is Nydia a COTA of 3 years and I was too a victim of PDPM, I was lay-off on October 2, I was taken into the DOR’s Office and was given the news that I was terminated that day, no warning no advance notice and I was not going to be pay my 65 hours PTO that accumulated. It was devastating especially with the holidays approaching. I have heard from co- workers that they have being seeing too many patients and the treatment is not what it should be, there is no client center treatment anymore, I hope things get back to what it was before, I chose this profession because I wanted to make a difference in people’s life not to meet productivity requirements!!!

      Posted by Nydia on 10/11/2019 12:23 PM

    • APTA is weakened by its love of government and large corporations, rather than supporting a vision for independent PT's. I was at CSM in San Antonio in a discussion group, I suggested that a pursuit of private practice in all settings would greatly benefit our profession . I was looked at like I had 3 heads. I suggested why not work to provide grants or even low interest loans for therapists who want to start a practice. If dentists and eye doctors can make it, my question is, why can't PT's go for it? You would get much higher quality therapy, wages, and ownership of practice.

      Posted by Casey Lauf on 10/11/2019 1:26 PM

    • The present administration does not care about any sick citizens of this country. Nor are they interested in supporting the hardworking health care professionals. The negligible coverage of insurance while charging maximum fees; the greed culture of American corporate and business is eating and destroying the very people who sustain it. Playing politics with health of people is never a good idea but unfortunately this is sad state of affairs which will destroy not only the health of our elderly and needy but the future of health care professionals. Which in tum will effect the country’s health.

      Posted by Ranjan Sen on 10/11/2019 6:39 PM

    • I feel for all the therapists who have been laid off or have reduced hours/benefits. This is not right. It just all seems backward. In an ideal world- The evaluation determines treatment plan as medically necessary and appropriate for the patient, then intervention and billing should be based on intervention. Payment should be based on billed charges for treatment provided. I wonder why the payment is driving patient care? If employers are laying off therapists based on PDPM then they are the ones at fault. APTA needs to find a way to support therapists by getting a list of all therapists and their employers and sending a complaint to CMS about these employers. CMS has its reasons for introducing the changes but misinterpretation is happening at the facility/ administration level. The end result should not be laying off therapists but getting them together to figure out the best way to implement PDPM while providing the necessary care to the patients. Looks like PT/ PTA’s need to step up and with support from APTA something can be done about this situation. Let’s look for a solution. I urge all therapists to have a louder voice but that will be heard only if you are part of the organization that is promoting our profession and working hard to move it in the direction it is supposed to. We need numbers and that builds strength. If we as a profession want to be successful like the dentists and eye doctors then we need to first value what we do and stand up for it. I wonder how many therapists actually have filed a complaint against their employer on work demands that did not seem ethical? All these years minutes were demanded and therapists provided them. How do we justify this being skilled? If it’s not right then why has it been done? Having a union will not change what is happening . We have to change how we do things for any change to happen. As long as we allow others to decide what physical therapy is and how it should be provided these conditions will be there. If we don’t stand up for our profession why should anyone else? Please get in touch with your State APTA chapter and work with them to change this. Don’t give up saying APTA is not doing anything. It is therapists who are running the APTA and want you all to join them so they can help. They want to help. There is strength in numbers. The question is are we all in this together for each other or just looking out for individual situations?

      Posted by Dimple on 10/12/2019 7:29 AM

    • PT's being fired and laid off left and right! Is that fair? NO! So what is APTA doing about it? NOTHING! APTA is supposed to represent our interests and concerns as PT's! I guess APTA is not as strong as the NRA! Now that is a lobbying machine!

      Posted by Drkiyangogg on 10/12/2019 4:48 PM

    • I have been a PT for 37 years starting with pediatrics and school based delivery rnagin to EI, and now SNFs. I have always believed in quality therapy delivery despite POC doc requirements and productivity requirements. Most of my therapy is hands on due to doing manual/MFR and working with patients with varying levels of dementia. Even when performing seated ther ex, I use the hands on approach for optimal performance and benefit to the pt. Irefuse to sit and type for 10 mins of a 30 min session while pt sits idly (which I often see). I might type when a pt is on the Sci Fit and require only supervision. Of course, I have been chided for productivity outcomes especially when supervising 3-4 LPTAs whole when part time and at times doing 6 recerts in one day. I really don't care what they say!! I do my best each and every day but remain true to my pt. It does get harder and harder participate in our current health care systems. I bring a certain skill set and knowledge base (in this age of brand new therapists being in the majority but are unable to contribute to pt care and supervisory needs logistically speaking) to the table which hopefully carries me through to the end of my stint. I experience great angst when pushed to conform to standards established by non-clinicians but try ot stay focused on the pt. I am not judging anyone else with my post -just saying my piece. Thank you

      Posted by Cheryl Kelley, PT on 10/13/2019 11:54 AM

    • All the interest now. PDGM is coming and it will be more significant in regard to impact on the workforce. That being said my company provides care in every PAC setting. We have been working since 2011 to diversify our offerings and evaluate how we can adapt based on MedPac recommendations to congress. As PT's we have evaluated our own individual practices across settings. We anticipated that 35-40% of SNF therapy provisions were over-delivered. At times this was corporate driven but realistically 25% of services were dictated by regulations. Why would I see 3 TKR's separately all week instead of grouping large %'s of their treatment? Three knees or hips on a mat equals great comradery and effective teaching. If 25% of my caseload is CHF why wouldn't I assign basic therex, basic activity related vital sign monitoring education, and simple bed mobility to an observed exercise tech so that 30 individual minutes daily could be more focused on skilled TA's to promote independence at home or lower burdens of care at a facility. BPCI and CJR taught us very quickly we can do better, more efficient, care in joints with less tx time and more education. 90% of SNF were delivering RU's to 90% of their patients???? Come on. We can do better and CMS is now forcing us to do better. We need to be focussed on how we improve the M1800's and section CC items. It is a little ridiculous that we have let nurses report this data on some of the least sensitive reporting tools in the industry. Compared to the FIM the SNFs and HHAs might as well be using rocks and hieroglyphics to report functional levels. I agree it is terrible what is happening in the workforce. That being said if we focus on what we do, provide research that shows impact on seniors, we can be properly positioned for the silver tsunami that is impending in the US. How many of us wanted a world in which the "minutes" didn't matter? Well--- we got it. Now we need to do something with it.

      Posted by David Jackson on 10/13/2019 12:15 PM

    • The APTA is a complete joke! This statement does nothing to actually start to fix the problem in our industry, which is corporate run healthcare companies. The APTA almost seems that they are shocked that this took place. The president of our association has a few advanced degrees (DPT, PhD..) but didn't see this coming; really?! These corporations do not care about patients, nor do they care about any therapist that they employ, whether it's PTAs, PTs, OTs, COTAs or SLPs. HEALTHCARE CORPORATIONS CARE ABOUT THEIR BOTTOM LINE AND NOTHING ELSE. P.S. the only reason that I am a member of this awful association is because DPT programs force their students to be a part of it; probably because they know that anyone in their right mind would not. Thanks for nothing APTA.

      Posted by Thomas A. Bloch, PTA, SPT on 10/14/2019 7:41 PM

    • The APTA is garbage. I knew this was going to happen the moment I heard the proposed changes. In my opinion, the APTA didn't care. They allowed thousands of therapists to take a significant hit. I don't see something like this happening to Chiropractors. Chiropractors's ACA is an association that actually works for its members. That why I'm quitting APTA. They are asleep at the wheel.

      Posted by Rick Ramirez on 10/14/2019 9:00 PM

    • I am super irritated by the tone of this article. "I do declare! I didn't know that corporations were going to choose profits over people! How dishonorable!" What a joke! LOOK WHO HAS/HAD ADDS ON THE APTA'S WEBSITE: GENESIS. Get out of your establishment bubble and see what therapists have been having to deal with: a corrupt healthcare system that never was focused on patient care. You essentially have created indentured servitude to these corrupt corporate health companies since PTs owe a DISGUSTING AMOUNT OF STUDENT DEBT! Do we all agree now that there is huge ethical issue with Fortune 500 companies owning PT practices?! They bully therapists with high debt to maximize profit. Way to not stand up for the therapists! If the APTA had guts, it would advocate that these corrupt companies are never able to receive payment from CMS. Being a member to this association is useless and I will most likely be ending my membership. Shame on you APTA. Do something other than platitudes.

      Posted by Michele Bloch, DPT on 10/15/2019 8:32 AM

    • if the company CEO of a publicly traded stock isn’t maximizing profits the next one will. I’ve been a rehab director and the conversation with upper management was only profits. It’s not ran clinically but based on the CEO keeping their job and their big bonus. That needs to sink in before the problem can be fixed. Big company Executives are NOT therapists mostly so they see only the money side of the SNF. Therefore, the less PT are involved the less payroll. After 93 + % productivity required when I worked in 2015 I can’t imagine doing this with the risk of job loss. I’m sorry for those who must endure this. PTs are passive and non-confrontational generally in my view so our profession gets pushed around. Plus it has mostly been ran by drs from it conception. Only recently becoming ‘autonomous’. YELL PTs!! call your Congress people with ideas. Don’t accept that corporate donors chose whether you have a job tomorrow based on them directing congressional law making. Demand CMS listens to the therapist. I’m writing letters to congress to fight for what’s right for the therapist and the pt. Going to town halls work. I’m disappointed that it was mentioned that someone felt the SNF would hold out a few months to assess before cutting jobs. That makes me realize corporations are not understood. Patients and PTs before corporate profits should be the theme. For the APTA, well I guess you try but we sure take a lot of abuse for as little of the annual Medicare budge therapy costs. Is that an indicator of the APTAs effectiveness? Just saying.

      Posted by Daniel Sheehy -> AIU`>L on 10/16/2019 7:43 AM

    • In addition to lost jobs, we also have another problem: lost clinical spots at SNFs. We are in the process of placing PTA students and have run into clinical instructors not being able to take students at SNFs due to the recent changes and layoffs. It was already challenging to place students in acute care settings, now we're going to have problems with SNFs.

      Posted by Caroline Peyrone -> ?GT^=N on 10/16/2019 4:47 PM

    • What is happening in homecare and SNFs has happened for many years in outpatient physical therapy and it is awful. I have practiced in this arena for 31 years and have owned my own practice for 17 years. The physician owned PT practices and the insurances that are affiliated with hospitals (University of Pittsburgh Medical Center) and insurances that own hospitals (Allegheny Health System and Highmark Insurance) in the Pittsburgh, PA and surrounding areas has greatly hindered the market for private PT owned practices. So not only is access to patients been very difficult but reimbursement has reduced painfully and paperwork and authorizations required have increased. I investigated the starting salaries for new graduate PTs in the Pittsburgh, PA market and they have not increased in outpatient PT in about 18 years!!! Most graduates get $55-58,000 but the price of the DPT has greatly increased. Scary times.

      Posted by Patrick S. on 10/16/2019 5:36 PM

    • Reading through all the comments especially David Jackson's comment I realized something about our profession of physical therapy. David wrote that when having 2 or 3 TKA patients, it is good to put them together and treat them as a group. In my opinion, this is what caused this problem for us. These patients might have the same surgical procedure done but what caused their condition will never be the same. More-over the surgical procedure was to correct the secondary problem and our job as physical therapy profession is to examine these patients to find what caused their condition that lead to surgical procedure. When we do these examination will realize that no 2-individual problem is the same and therefore, you can not treat them together. However, if the only thing you are doing is to increase the knee range of motion to satisfy the surgeon . Then I believe you can group them. David also mentioned of CHF patients being group together i do not see how you can professionally do that unless you do not know what you are doing and that is what brought us here. I believed that our clinical training is not adequate and majority of us as physical therapist do not know what physical therapy is in medicine. I get annoying when see or hear that we are movement professional because physical therapy is more than that and it is high time we wake up before we loss the whole profession. There are some other comment about Dentist. For those that remember history Dentist in this country in seventies and eighties, they are poor and some of them changed their profession but not until they change the way they practice and re-organised, today they one of richest health care professional. We as physical therapist have to change the way we practice and start practice as a professional not as a technician. Let face it look at the CMS policy, our plan of care for our patient need to be signed by a physician or physician assistant or Nurse practitioner. Is it because we do not know human anatomy, physiology or the pathology of the conditions that we are treating. When we change this policy , we will have direct assess to our patient and this kind of what is happening now will not happen again because by then we are full professional in medical field. I am sorry that my colleague are losing job but we have to practice like a professional and thoroughly understand our profession. thanks,

      Posted by Raifu Olorunfemi on 10/16/2019 7:16 PM

    • Today our Regional Director sent an email directing all DORs in her region (Fl) to single out therapists not meeting the 25% Group Mandate...bring them into the office and have them sign a “Plan of Correction”. Never asked for the clinical rationale. They have financial benchmarks.

      Posted by Jason on 10/16/2019 10:00 PM

    • Unfortunately folks, this is only going to get worse. I have been writing about this for years, seeing the handwriting on the wall, and it is all coming to pass. Between a repressive government, greedy insurance corporations, and a professional association that is failing in its mandate, we will wind up working harder and harder and being paid less and less. If our organization would pay half as much attention to getting us proper reimbursement as they do to "diversity", "inclusivity", "cultural sensitivity", "bias", and a host of other political correctness issues sourced in critical theory (which in turn is sourced in marxist theory), we'd be a lot better off. Regrettably, that is unlikely to occur. You'll need to organize as a union, have visible and effective mass protests, employ some other forms of civil disobedience, boycott, and strike OR slowly wither on the vine and die. Read books such as Sharp's Dictionary of Power and Struggle by Gene Sharp and Rules for Radicals by Saul Alinsky to familiarize yourself with your political options.

      Posted by Brian Miller on 10/17/2019 12:03 PM

    • Seema Verma’s husband is an MD. You have a new law that has caused layoffs to SNFs/rehab facilities. The next law is set to effect home health and then additional cuts to outpatient are on the way. This is a direct attack on our profession and other professions as well. This is why unelected bureaucrats should not be making laws. The constitution does not allow for it but it’s exactly what is happening. A good book to read on this is Undemocratic by Jay Sekulow. We will have to find a way to deal with this. We need to find PTs who want to run for office and support vision 2020 and then back them with money and other support. We may need to form a union. We need more DPT/JD programs. We need laws to only come from congress and not unelected bureaucrats. I’ve seen many negative comments about the APTA. This is not the time to bash. The future of this profession will depend on intelligent leadership. We don’t have much else. PTs should be flocking to APTA membership. We need it to be stronger, not weaker.

      Posted by Bob on 10/19/2019 1:08 PM

    • Changes are not a myth! They’re a reality. Wake up, APTA. Please help your therapists! My company, which I shall not name, has the Assistants, grouping part A’s at 50%— boss not scared of getting caught one bit; part A minutes were dropped in HALF! on October 1st. Productivity raised to 100% for assistants and 95% for therapists.

      Posted by Can’t leave my name or I’ll get fired on 10/19/2019 6:06 PM

    • This is my 2 cents. I have been a member of the APTA for 30 years. I have seen challenges like this coming and I am not surprised. The base of our profession is not unified. If it was, these payment models would not be happening or imposed on us. One problem is we have a three tier system for PT's. BSPT, MSPT and DPT's. Many of the PTs that I worked with, left the association when the tier system started. This fractured the base. I am all for better educated PT's. I have been taking continuing ed for the past 29 years. Putting the D in front of PT has not placed us in more private practice settings or gained us better payment solutions with insurance companies. I have been in private practice for 27 years and have six therapists that work for me. Name another profession that has different tiers for their members. eg; BSMD, MSMD or DMD. No they all are MD's. Someone mentioned chiropractors in the previous comments, they all are DC's. I don't think we should get mad and leave the Association. I plan on staying. The APTA needs to start focusing on unifying their base. I don't have the answers but I see this as the first step in getting everybody on board for a common goal.

      Posted by Mike on 10/19/2019 9:56 PM

    • APTA does not care about us. They knew these changes would kill our profession. Lead to massive lay offs, pay cuts, and higher productivity standards. But they don’t care. I really feel for the students who have no idea they will have 120-150,000 in debt. This profession is so screwed up. I have been working 7 days a week just to pay the outrages student loans for the past 10 years and still owe over 30,000 despite paying $1450 a month with never getting a pay raise and actually a pay cut with reduced benefits. APTA is a joke with no power what so ever. Time to form a union! If not, we will continue to piss on and laughed at by APTA and the profession! What a joke this profession! Edward Schmidt, DPT PT PS: Was never a member of APTA as a student or clinician because therapist was no reason! What a joke APTA is!

      Posted by Edward Schmidt on 10/19/2019 11:42 PM

    • I today have decided that after 20 years of being a PT I'm not returning. It has literally made me sick to my stomach what we as professionals were forced to do under PPS. I have seen so much fraud bbn it was common place. When I first heard of PDPM I was exhilarated then it hit me... I said wow there will be layoffs. I was one but honestly I was going to give notice anyways because the months leading up to oct 1 the fraud that was always there but quite concealed. Any seasoned therapist can spot it but then it was all out in the open and the passive aggressive comment of "I dont care how you get the minutes just do it" turned into threatening emails and notes written on our schedules. Well I took all of them with me on my last day and had a very interesting conversation with OIG and just initiated whistleblower claim against Genesis. I have clear instructions in emails from regional manager saying very fraudulent statements regarding billing categories and there will be no excuses accepted for missing minutes. She actually stated that losing revenue is not an option so all new med A admissions must be placed at RU but to make sure the projections "look like real life" no zeros or 5's and to not have more than 2 units of overage. They are going down this time!

      Posted by Gwen on 10/20/2019 1:35 PM

    • Got laid off on oct 4, after 12 years with same company, along with four other therapists... now they just opened up PRN positions!! No positions opened in area. Thinking bout going back to school, need to get away from Medicare an do something different...

      Posted by Out of work on 10/21/2019 6:26 PM

    • Just got word that today will be my last day being replaced by a new grad PTA. I have been a PTA for only three years and now I wish I would have listened to all those who told me about the impending future of physical therapy and to find another career, but I didn't listen, now I'm out of a job and a career. I'm 56 years old so a lot of companies won't hire me because they look at me as a risk. I've heard a lot of rehab companies around the area have laid off so many therapists that people are taking whatever they can get their hands on.

      Posted by Karen J in Ohio on 10/21/2019 9:40 PM

    • Layoffs are here and it's going to be a long road for the next two to three years. I work for one of the largest rehab companies in the industry with 7 of the 11 therapists in my building getting their ax on October 1 not to mention company laying off 34% of their workforce which also included upper management and executives. All I've been doing is concurrent therapies traveling between three buildings a day. I was told if I refused to participate I would be written up or face termination. Other therapists I work with were told the same thing. Been a COTA for 40 years going thru PPS in 1998 and it was a bad time for all of us. I have a feeling it's time to throw in the towel and move on

      Posted by Michael S on 10/21/2019 9:50 PM

    • This article is BS- unless you have done the calculation of the case mix index/ rate, then one has no right to judge the SNF administration. In the SNF setting, one has to be able to know and recognize the need to balance business and patient need. If we continue as it was during the RUGs system, then there will be not enough money to pay the entire SNF staff as well as the expenses incurred. Come to a SNF, scrub a chart and project your payment/day- and if you see that there should be no change, show us!

      Posted by Maria Greenflower on 10/21/2019 10:17 PM

    • I was another victim of layoffs due to the changes starting at the beginning of the month. I am a week and a half shy of my 5 year anniversary date which means I probably lost all my vacation time as well. My boss is still looking into that. They are keeping me PRN but I most likely wont be working due to the company limiting the use of PRN staff at this time to almost not at all. I knew it was coming and have went back to school. After 18 years of fighting to work as a PTA in michigan, I am done. Our jobs will be non existence soon, so it's time to move on.

      Posted by Angel Vanskike on 10/22/2019 2:41 PM

    • 25 years as a PTA..the greedy corporations and therapists, PT, OT and ST have done a fine job of digging their own graves by treating patients who are NOT appropriate for therapy, just so they can bill Medicare and line their pockets! I’ve seen it in SNF and HH. Now the rules have changed and everyone is upset?! How long did you think we could continue to abuse the system?? I left SNF years ago because of the “minutes game”. 90 minutes of therapy for an elderly B AKA, who also has one arm amputated?? When I asked, why, I was told, “do the best you can”. Give me a break!!

      Posted by Teresa S on 10/22/2019 9:10 PM

    • Well, I got the axe last year when I was fired from my job with Intergro Rehab in California for refusing to commit Medicare Fraud. I new all about PDPM but none of the therapists would believe me, now I hear that 85% of the staff were laid-off October 1st and can't find work. I no long work in healthcare but it wasn't an easy choice since I was a COTA for 40 years and it was the only thing I knew. PDGM is next for Home Health beginning January 1st, 2020, so 'm sure there will be mass layoffs their too.

      Posted by Rick on 10/23/2019 3:53 PM

    • Therapists are trying to unionize: https://www.facebook.com/groups/2194533220675276/

      Posted by Thomas A. Bloch, PTA, SPT on 10/30/2019 9:24 AM

    • The union is not the answer nor will it keep staff from getting let go. As a PT I like knowing I can negotiate for myself. Trust me in the facility where I work the nurses and other staff are union and the union is not the answer!!!

      Posted by justin on 11/4/2019 3:11 PM

    • Corporations have an obligation to their board to maximize profits, period. Corporations do not care about the therapists and certainly do not care about the patients. They care about profits. Therapists need to unionize so that we can negotiate as a collective, and actually progress as a profession.

      Posted by Thomas A. Bloch, PTA, SPT on 11/6/2019 4:54 PM

    • With all that we went through to get this DPT and the school loans we still have to pay. It's just not right. I am so frustrated. I did most of my clinical affiliation in SNF hoping to make a difference in older people's lives. Now I am here laid off. Come on APTA what are you guys here for. What is currently going on with this PDPM system should not result in therapists layoffs. We truly do not deserve this. May CMS needs to find out the amount of education required to get a DPT and how hard it is to pass the national board exam.

      Posted by Abdoul Diagne on 11/17/2019 11:43 PM

    • Wow, what a thread of comments! Let's all look in the mirror. All of these changes and indiscretions happened because WE as a profession allowed it. The APTA is a voluntary organization that, at best, has 30% of our profession as members. (https://www.apta.org/MembershipMatters/FAQ/) It's most detrimental contribution has been the "professionalization" of our profession via increased education, first with MS, then with DPT. More education and a never ending list of arcane, indecipherable initials after a name does NOT mean better clinicians; the application of that education in the clinic does. Direct access in all 50 states? A facade that is only applicable in a limited number of settings who accept cash only. Patient's who want to utilize insurance still need a physician referral. And reimbursement rates from those insurances? A joke. The APTA would have more members if it truly listened to and responded to the needs of the profession with a stronger lobby, as some pointed out in earlier comments. Any of us (BS, MS or DPT) who worked for any company, in any setting and acquiesced to the management "to keep our job" are responsible. Any of us worked off the clock to finish documentation, supervised too many PTAs, allowed or participated in groups that did not meet the needs of EVERY patient in that group, performed ankle pumps and LAQ with each and every patient, are responsible. And any of us who observed any of these egregious and unethical acts and said or did nothing, are responsible. WE created this culture of providing poor therapy for poor reimbursement because WE deliver it. Unless WE (every PT and PTA) start working to CHANGE the culture by treating EVERY patient the way WE would want to be treated, nothing will change. BE the change!

      Posted by Rick Castellini on 11/19/2019 12:25 PM

    • I was "terminated" in October from a company I worked for since 2014 where I went from ADOR at 1 facility to this. I am a COTA/L almost 10 yrs in therapy and 5 as a CNA. At my age 32 I'm trying to find any job and they are all prn or part time and had no idea this would be the outcome. I would have filed for unemployment that day but thought, I'll find another job no problem. Now, is time to take action.

      Posted by becky on 11/25/2019 4:16 PM

    • Are you serious? The APTA? They haven't advanced our profession in twenty years! The schools force their students to join the APTA, otherwise their grades suffer. They proposed the DPT degree would help with direct access and salaries, which of course it did not, it just added more debt to the students. The only thing our profession needs is to be completely independent of physicians. Eliminating Physician Owned clinics is the only way. WE HAVE THE POWER. They must send their patients to rehab, and the Medicare laws support this. Unionize, monetize, and become a truly independent profession!

      Posted by Kevin on 12/9/2019 10:31 AM

    • are you going to leave my comments or not let my voice be heard?

      Posted by Kevin on 12/9/2019 3:40 PM

    • After retiring from private practice, and working PRN for several rehab companies, it became apparent that greed drove therapy minutes, not patient needs. How many times did I pick up my assignment sheet and see diagnoses like end-stage kidney disease, CHF, COPD, even metastatic cancers, and have 60+ minutes assigned for the session? And the hammer fell if I documented patient refused, or unable to tolerate low-level activities during therapy. The RD would send in a COTA or PTA to get the incompleted minutes by doing mind-numbing bullshit therapy, like playing cards, or folding towels, then document word salad notes which would pass muster if audited. And how many times did I see the SD berating a pt for refusing therapy, stating that they'd have to pay for their stay because MDR wouldn't cover the bill if they didn't do their therapy? And the RD coming back from closed door meetings with the administrator, tears in eyes, from being chewed out for not keep RU levels up. And then seeing so many unethical RDs, who were given bonuses based on high % of RU pts. How many times was I TOLD I HAD to meet those minutes or my hours would be cut. I didn't have the financial pressures on me like my colleagues. So I'd basically tell them to find someone else to do their dirty deeds. Then they'd just hire a new grad traveler who just wanted a big paycheck and would bullshit their way through the day doing what was assigned. The entire profession has been compromised. And now the writing is on the wall, jobs will be hard to find. We screwed the pooch. Karma's a bitch

      Posted by Vi Pacheco on 12/23/2019 12:50 PM

    • I'm an occupational therapy assistant who was laid off October and even though I have submitted my resume to several and I mean so many companies and recruiters and what have you, to the point that if somebody does call....or email primarily, I don't even know what company or recruitng service it was for, which doesn't help if it is the potential first-hand interview!! I do receive emails saying I need to complete the second portion of the resume and even though I did complete said resume and references I continue to get emails saying that I need to complete the 15 page online form that I already completed..an automated response..same as what I received when initially applying. I try to reach out for information via phone and email yet...still receive automated bs. I have yet to be employed and I've been practicing 9 and 1/2 years. Unfortunately I feel there is nothing being done and research information seems to have all been posted from October which scares me terribly. Now, my father is completely responsible for paying my bills which has caused such stress and days of crying that I too have the option of either going back to school at the age of 33 or continue searching for some BS job.. that's not going to probably pay me what I deserve.. even when I was let go the regional director said and I quote it's obvious that you know exactly what you're talking about and you are very knowledgeable and on your termination papers I won't put down that you're not eligible for rehire unquote... I did say to her it's funny going from being assistant director of rehab at one facility to being terminated over a verbal warning due to a shirt that apparently when I bent over revealed my bra. I seriously laugh in my head. I did, in front of the regional director make my DOR who initially wrote that warning, that after speaking over an hour about insignificant things.. that she told me that we were going to "discard it because I corrected the issue" which she said "yes I did say that.." yet come to find out during my termination meeting she sent the regional director a text saying that I refused to sign the paper versus what she initially told me and making her admit in front of the head honchos along with several incorrect information she provided them does make me feel some Revenge. In the end I worked for this company approximately 6 years floating around Illinois only to be discarded like many others.I finally had to apply for Medicaid as embarrassing as that is, it is what it is and as many comments and petitions I sign I really feel like nothing is being done at this current period. Severely depressed, lonely, and worthless is what I hear from my father and I understand he wants to retire however things will change... I am strong and I know I am none of those things above.... but thank you so much to these wonderful corporations I wonder if I can sue for PTSD? I thank you for the new therapy model really seems to not make any sense it's all about money now however, I regret anything I ever said about getting 75 50 51 32 minutes with a cancer patient who is stage 4 and bs my way through the session simply talking to them occasionally having them lift their arms and documenting that as completing active range of motion to promote bs bs bs... thank you for reading my rant I needed to let it out to others that understand how the therapy World works.. can't wait till next October!

      Posted by Rebecca on 1/3/2020 10:51 AM

    • The fact is that the new payment system of PDPM gave SNF rehab providers a group & concurrent loophole to exploit. SNF business are taking disadvantage of this new system and CMS or any other responsible authority should take appropriate action to stop this. As a clinician we should focus on providing best quality care which is patient focused and their need not payment system.

      Posted by Hitesh on 1/31/2020 12:08 PM

    • PDGM*!%@....to be polite. Many jobs are being lost. Every week for the past 1 month I have had 25% fewer visits per week. Now down to seeing 8 visits this week. Like someone said earlier, I have also applied to many companies but have heard no response. I have 15 years experience as a PTA and now its come to this. No job security. Guess its time to for a career change.

      Posted by dubit on 2/3/2020 8:33 AM

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