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  • APTA, AOTA, ASHA: New Home Health Payment System No Reason to Compromise Care

    As a new Medicare Part A payment model for home health agencies (HHAs) gets set to launch January 1, APTA and two other provider organizations are urging HHAs to keep patient access to needed care front-and-center, and not react to the new system with "unnecessary staffing changes."

    In a joint statement by APTA, the American Occupational Therapy Association (AOTA), and the American Speech-Language-Hearing Association (ASHA), the organizations state:

    "APTA, AOTA, and ASHA are aware of the potential for clinicians and assistants to be negatively impacted by the reactions of some home health agencies when implementing Medicare’s Patient-Driven Groupings Model (PDGM) on January 1, 2020. Unnecessary staffing changes could affect the clinicians’ practice patterns and their ability to exercise clinical judgment, as well as patients’ access to care — ultimately damaging the quality of therapy provided by home health agencies. Our organizations continue ongoing dialogue with CMS and home health agencies to ensure that Medicare beneficiaries continue receiving the skilled therapy they need. APTA, AOTA, and ASHA are committed to advocating on behalf of our professions and the people they treat."

    The statement summarizes one of the central points APTA, AOTA, and ASHA have been driving home since PDGM was finalized for implementation on January 1, 2020: that PDGM changes nothing in terms of CMS' requirements that HHAs provide high-quality reasonable and necessary rehabilitation services and that clinicians use clinical judgment in determining appropriate frequency, duration, and modality of services.

    As the new system is implemented, the association will be gathering on-the-ground information from physical therapists and physical therapist assistants on how HHAs are responding, and will share those reports with CMS. CMS will also be tracking utilization and patient outcomes under PDGM to ensure appropriate provision of therapy. If you have experiences to share related to implementation of PDGM (or the SNF PDPM), reach out to advocacy@apta.org.

    Learn the basics of how you can manage the PDGM in this "Compliance Matters" column published in PT in Motion magazine. Need more information? APTA has created an entire PDGM webpage with multiple resources to help you understand and make the case for your value in the system.

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    • Contrary to popular belief, this new model will compromise care. Company’s have influenced the amount of therapy delivered for years, yet this new model doesn’t penalize them, it penalizes therapy clinicians and patients. Big companies have already cut pay, hours, and visits per episode. We are expected to get paid less, do more, and have better outcomes. While I do think we have been lazy with our scope of practice and not operated at the tops of our licenses, we don’t deserve this form of treatment. Unless something changes in the coming months therapists and patients will suffer significantly. I wish our organization or our profession would do something to combat this. Not putting something in the home health frame work to ensure therapy is delivered appropriately will make us all suffer. Home health agencies will just adjust numbers off of oasis and make things look good. Rehab is in trouble.

      Posted by Bethany Christopher on 12/20/2019 8:16 PM

    • The next round of layoffs will start in Jan.......APTA, AOTA, ASHA should not take any sponsorship from any of these corporations that are laying off therapists. A union is forming: americantherapyalliance.org

      Posted by Thomas A. Bloch, PTA, SPT on 12/21/2019 8:14 AM

    • Physiotherapy and Occupational Therapy should change as one profession, then only we can take everything.

      Posted by Jude on 12/23/2019 10:19 AM

    • I fail to see how unionization is going to change how CMS and other payers increase reimbursement. CMS has the responsibility to provide high quality care at the lowest possible cost. Unionization will lead to further fracturing of our profession. The answer to our problems is a cap on tuition costs at the Universities, partnering with payers and employers for preventative medicine and alternative payment models, and reduce fraud in our profession. Home health companies should be looking at how to properly care for patients and transition them to the next level of care when appropriate. Countless times I have had patients receive 4-6weeks of home health after a THA or TKA because home health agencies limit progression into the next level of care. Your group is trying to become a non-profit because it is easier than becoming a union. Please do not confuse 20,000 signatures on a Facebook account as true support for your cause. I refuse to join a union or non-profit that will inevitably have high administration costs with poor results.

      Posted by Anonymous on 12/23/2019 6:28 PM

    • Many talk about the new payment model as potentially comprising care. The opposite is true because more PT/OT does NOT enhance care, it in many cases diminishes care. How does providing a large amount of unnecessary PT/OT service enhance care ? It doesn’t! More PT in some instances detracts from the patients care the patients can be physically over taxed and put in situations in which they are forced to receive treatment in conditions that cognitively over burden their senses. Probably a third or more of PT patients in SNF’s and HH have some form of confusion. What’s our solution? Take them to a loud therapy gym and give them Instructions while at the same time, the person next to them is recieving instructions. Bottom line, in most cases, less or no PT/OT enhances care instead compromising it.

      Posted by Matt on 12/25/2019 3:06 PM

    • @matt I don’t know what setting you practice in, but your answer seems to be uninformed. While there are companies that pushed therapists to over provide services, a majority did not. We went from possible over utilisation to now under utilisation. If a physical therapist is treating a person in a loud distracting environment then they aren’t a very intelligent/practical therapist. We also do much more in these settings such as woundcare, setting up homes to maxmize independence, medication reconciliation, and fall risk reduction programs. If I patient is confused, a caregiver needs to be present to help enhance the effectiveness of treatments. This new model is going to caused company’s to over react to providing therapy services because there’s nothing in the new model to promote the use of therapy. Unfortunately a lot of companies don’t put their patients first. The APTA also talks a lot about advancing our profession, yet vision 2020 is here, but we really don’t have direct access at all, while chiropractors have it. Makes no sense for a medical point of view, but here we are.

      Posted by Gerald on 12/26/2019 2:39 PM

    • I am a HH DPT. Our company is changing my frequency and duration, even with the frail patients. This has resulted in rehospitalizations of a few of my sickest patients. How can we monitor them when we are only seeing them one time a week? Hence, return to the Ear due to decline and lack Of appropriate care. More government interference results in more deaths and therefore, the government saves money.

      Posted by Dr. Renee Hill on 2/2/2020 8:31 AM

    • I have been a home care PT 19 years. I am angry, disillusioned and extremely sad about what is happing to the quality of care that my patients are now receiving as a result of PDGM. I have been totally blindsided by the ramifications of PDMG and never expected that I would have too compromise the care I give to my patients. The private home care agency I work for is telling us how many visits we are allowed based only on the functional level of the patient. Our clinical expertise on the frequency and duration of PT visits to achieve set goals has no bearing. If we are given 13 visits for a 60 day period we have to share those visits with OT and ST as well. We are supposed to talk among ourselves and decide which therapy a patient needs more and then most of the visits will be made by that discipline. We also are told that we can only use 70% of the visits during the first 30 days and the other 30% in the last 30 days. So as a result I am now seeing most of my patients once a week and are told that I must discharge when they are independent with an assistive device in their home despite the fact that they still have weakness, balance and endurance issues and are far from their prior level of function. We are instructed to refer our patients to out patient PT despite the fact that most of my elderly patients do not drive or have anyone to take them. Besides being hit hard by the loss of revenue from a significant decrease in PT visits, I am most sad for my patients who are not getting the care they need and are too old and frail to advocate for their rights.

      Posted by Didi on 2/6/2020 6:05 PM

    • @ matt...sorry but ur comment is very offensive to me...Im a board certified geriatric doing home health care PT for 20 years. Let me ask u...do u know how to deal geriatric populations witm complex & multiple chronic cnditions & not only that with multiple functional impairments as well....please show me how expert you are on how to bring them to their highest level of functioning ex. 1 wk 4...if u can improve them with this Rx frequency I will salute & vow to you. ..please dont devalue home health therapists (PT, OT & OT). Im sorry but u must be hearing something from jealous people or professionals & for BAD home health clinicians...Dont worry they they wouldnt last in home health coz they wont get rederrals from HH companies if they keep poor & substandard care to their patients...lastly, try to do home health here in Chicago esp in drug & gand infested hoods will see if can do it...

      Posted by KAHLIL A CALVO on 2/8/2020 9:31 AM

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