Therapy Services

Need vs. Cost

Alex Spanko at Skilled Nursing News had a remarkable article about the need for therapy in nursing homes. He references a self-serving new study by lobbyists for physical and occupational therapists that show increased intensity of therapy services may directly lead to better outcomes for nursing home residents.

Residents getting 90 to 219 hours had the lowest rates of 30-day hospital readmissions. The American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) published data analysis.

“The study provides clear evidence that physical therapy and occupational therapy services improve patient outcomes across all PAC settings,” the groups concluded. “Findings consistently indicate that these services are associated with greater increases in function, suggesting a high potential for harm to patients who receive the fewest minutes of therapy.”

History of Fraud

Unfortunately, the data is old. It predates the way Medicare pays for therapeutic services in nursing homes. The Patient-Driven Payment Model (PDPM) took effect on October 1, 2019. The PDPM reversed incentives to defraud Medicare by falsely inflating therapy needs. PT and OT staff levels dropped up to 10% in the wake of PDPM. Total overall therapy staffing minutes per patient-day declined by 5.5% in the week immediately following PDPM’s implementation in October 2019.

The findings have researchers concerned that the declines will have negative impacts on the workforce and quality of services that residents receive in the future.

Of course, facilities should provide essential services when needed. However, transparency and accountability are necessary to prevent fraud.  We have seen many residents suffer injuries during unnecessary services.