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View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
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View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreThis article originally appeared in the August 2019 issue of Provider Magazine.
By Andy Kramer MD, CEO and Founding Partner, Providigm, A HealthStream Company
With implementation of the Patient-driven payment model (PDPM) Around the corner, there is much being written about the virtues of basing payment on clinical characteristics and the reduced administrative burden of fewer assessments. While few would argue with both of these benefits, the fly in the ointment is what will happen to provision of rehabilitation services and rehabilitation outcomes without incentives to provide rehabilitation.
The assumption is that providers will provide the amount of therapy that a resident requires, and the classification into physical therapy, occupational therapy, or speech-language pathology groups will ensure that payment is adequate. As simple as this sounds, there are challenges with this assumption.
First, several studies in recent years have demonstrated that the more therapy services a skilled nursing facility (SNF) resident receives, the better the rehabilitation outcomes.
For example, a recent study showed that each additional hour of therapy received per week was associated with a 3.1 percentage point increase in the likelihood a SNF resident was discharged home.
A recent Medicare Payment Advisory Commission (MedPAC) report showed that for every hour of physical therapy per resident day at the facility level there was a 6.9 percentage point increase in the facility rate of mobility improvement and a 16.7 percentage point increase in the rate of community discharge.
The dilemma is that, other than “more is better,” we do not have data on how much therapy is necessary to improve outcomes for different types of residents. Moreover, the development of PDPM did not take outcomes into consideration when determining therapy groups or payment.
This is compounded by the Centers for Medicare & Medicaid Services (CMS) dropping the community discharge outcome measure from public reporting. Furthermore, the functional outcome measures recommended by MedPAC have not been adopted by CMS. Thus, the only measure of rehabilitation outcomes is the minimum data set quality measure representing the “percentage of short-stay residents who made improvements In function,” which is notoriously insensitive to outcomes of rehabilitation.
Some evidence exists that just as with nurse staffing hours, there is a level of therapy provision above which SNF residents receive little additional outcome benefit. This amount of therapy is about 720 minutes, equivalent to the current ultra-high rehabilitation resource utilization group (RUG) level. Perhaps it is appropriate and beneficial that, increasingly, residents are receiving this amount of therapy in SNFs. Under PDPM, we will see how many residents still receive this or similar amounts.
If more therapy and a more robust rehabilitation program produces better outcomes for elders, are we setting up SNF residents for worse outcomes under PDPM? Possibly. That is not to say we should go back to payments based on therapy minutes. However, we should invest in rigorous measurement and reporting of rehabilitation outcomes under PDPM, so both providers and residents can optimize care, and CMS can adjust payments accordingly.
As stated by T. Franklin Williams, one of the founding fathers of geriatrics, “The aim of rehabilitation, to restore an individual to his/her former functional and environmental status, or, alternatively, to maintain or maximize remaining function, should be at the heart of all care of aging persons.”
About Providigm
Providigm, a HealthStream Company, creates practical solutions that healthcare providers can use every day to improve quality. We bring together scientific capability, clinical expertise and information technology in a single organization to solve the most pressing challenges that providers face. Our goal is to assist providers in meeting the evolving requirements of healthcare consumers and policy makers.
Learn more about HeathStream workforce development solutions for the Care Continuum.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsHealthStream's EMS Program offers a comprehensive, CAPCE accredited EMS course library that meets National Registry annual recertification.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's Provider Credentialing, privileging, & enrollment solutions.
View All CredentialingExperience standardized and centralized healthcare credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
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