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  • The New Postacute Care Payment Systems: 5 Tips to Help You Find Your Way

    There's no doubt about it: the new payment system that the US Centers for Medicare and Medicaid Services (CMS) put in place in October for skilled nursing facilities (SNFs), and the system that will start up for home health agencies (HHAs) on January 1, 2020, represent major changes by Medicare. And like most major changes, the new approaches have sparked myths, misunderstandings, and inaccurate interpretations—sometimes at the expense of physical therapists (PTs) and physical therapist assistants (PTAs) who work in the SNF and HHA settings and their patients.

    Discussions on what would become the new systems—the SNF payment model is called the Patient-Driven Payment Model (PDPM) and the HHA approach is known as the Patient-Driven Groupings Model (PDGM)—began 3 years ago, and APTA immediately began a dialogue with CMS that continues to this day. Those interactions, fueled by strong grassroots efforts among APTA members and other stakeholders, have helped to shape final rules that are far from perfect but significantly less problematic than many of the early proposals from CMS.

    The reality, however, is that PDPM and PDGM are here, and PTs and PTAs must now learn how to navigate the changed landscapes—and help dispel misunderstandings. Here are 5 things to remember about the new systems.

    1. PDGM and PDPM are changes to payment, not benefits. While some in the postacute care industry have characterized the new systems as a shift in benefit requirements, that's just not true. CMS expects that providers working in both systems—including rehabilitation professionals—will continue to use their clinical judgment to deliver high-quality therapy services that are reasonable and necessary. APTA communicates with CMS regularly on what we hear from members about employers' mischaracterization of the new rules—and CMS is listening (see tip 5).

    2, APTA offers multiple ways to learn more about the models. In addition to our advocacy efforts, we've developed free, publicly available education on the PDPM and PDGM: how to prepare for the changes, as well as how to advocate for and demonstrate the value of the PT and PTA within the new models. If you'd like to dig even deeper and find out what your peers are thinking about the models, check out this free downloadable recording of a recent webinar on postacute care reforms and the continued value of PT practice. A follow-up live Q&A is scheduled for December 13 at 1:00 pm, ET.

    3. PDGM and PDPM don't change what's important to practice. Any new payment system can be subject to misapplication—whether purposeful or not. But those misapplications should never affect the profession's commitment to ethical practice and the prevention of fraud and abuse. APTA's Center for Integrity in Practice website helps you better understand these issues in the context of best practice and reduced risk.

    4. The new systems may open up opportunities. Can changes to payment systems actually strengthen the case for rehabilitation services? Mahmood Iqbal, PT, thinks so. In a two-part blog series for APTA's #PTTransforms (part 1, part 2) this PT and HHA CEO takes a close look at the PDGM and sees a path that could make the role of the PT even more central to care. And while the posts focus on the home health setting, many of Iqbal's observations apply to PDPM as well. Want more perspectives on how to get the most out of the new models? Check out resources from APTA's Home Health Section, the APTA Academy of Geriatric Physical Therapy, and the association's Health Policy & Administration Section.

    5. CMS is watching—and we're listening. As the rules were being debated and developed, one of APTA's major areas of focus was around ensuring that CMS pays careful attention to utilization and outcomes. Our efforts, and the efforts of our collaborators at the American Occupational Therapy Association and the American Speech-Language-Hearing Association have resulted in CMS establishing regulatory guardrails that help to ensure that patients continue to receive the care they need.

    At the same time, APTA is committed to supplying CMS with on-the-ground information about how PDPM and PDGM are working for individual professionals. Your story is important—reach out to advocacy@apta.org to share your experiences.