Payment, Policy, and Advocacy
Skilled Nursing Facility PDPM Resources
CMS news
- CMS - Patient Driven Payment Model
- PDPM updates
- MLN Matters Article MM11152 - Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM). Learn about the required changes.
Tools/Resources
- Group vs Individual Care Decision Tree (.pdf)
- Documenting Support for the Decision to Use Group Therapy (.pdf)
- What You Should Know About the Patient-Driven Payment Model for Skilled Nursing Facilities
- SNF - PDPM FAQ
- APTA - Medicare Payment and Policies for Skilled Nursing Facilities (SNFs)
- Therapist Readiness Tool: A Self-Assessment
Webinars
- Post-Acute Care Update - 25 min video on PAC payment reform, demonstrating value, and looking ahead to the Unified payment system
- CMS Functional Outcome Measures - This webinar will describe the self-care and mobility measures. It will be important for therapists not only to understand the measures and their component elements, but also to insure their processes for collecting data are reliable and accurate. CMS will be using these to monitor quality of care!
- APTA - Overview of PDPM Ð 2/22/19
Other Helpful Information
Home Health PDGM Resources
CMS news
- CMS - Home Health Patient-Driven Groupings Model
- PDPM updates
- MLN Matters Article MM11081 - Home Health Patient-Driven Groupings Model (PDGM) Ð Spilt Implementationis available. Learn about the payment reform requirements.
Webinars
- Busting the Myths Associated with PDPM and PDGM
- APTA - Overview of PDGM Ð 2/19/19
- Post-Acute Care Update - 25 min video on PAC payment reform, demonstrating value, and looking ahead to the Unified payment system
Other Helpful Information
Long Term Care Hospital Resources
CMS news
Tools/Resources
Webinars
- Post-Acute Care Update - 25 min video on PAC payment
reform, demonstrating value, and looking ahead to the Unified
payment system
Inpatient Rehabilitation Facility Resources
APTA Post-Acute Care Resources
- Medicare PostAcute Care Reform
- Issues Impacting Postacute Care
- A Safe Alternative to Opioids for Pain Management (.pdf)
- The Value of Physical Therapy in Preventing Falls (.pdf)
- The Value of Physical Therapy in Preventing Readmissions (.pdf)
- The Value of Early Mobilization (.pdf)
- The Value of Group Physical Therapy (.pdf)
- Group vs Individual Care Decision Tree (.pdf)
APTA Post-Acute Care Resources
- Medicare PostAcute Care Reform
- Issues Impacting Postacute Care
- A Safe Alternative to Opioids for Pain Management (.pdf)
- The Value of Physical Therapy in Preventing Falls (.pdf)
- The Value of Physical Therapy in Preventing Readmissions (.pdf)
- The Value of Early Mobilization (.pdf)
- The Value of Group Physical Therapy (.pdf)
- Group vs Individual Care Decision Tree (.pdf)
Tools/Resources
Webinars
- Post-Acute Care Update - 25 min video on PAC payment reform, demonstrating value, and looking ahead to the Unified payment system
- CMS Functional Outcome Measures - This webinar will describe the self-care and mobility measures.
It will be important for therapists not only to understand the measures and their component elements, but also to insure their processes for collecting data are reliable and accurate. CMS will be using these to monitor quality of care!
Recent News
CMS says the PDPM is 5% more costly than the previous payment system, and warns SNFs to not let finances “override” clinical judgment.
In this review: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022 (proposed rule)
The study of nearly 9,000 patients also looked at the potential role of patient mobility at hospital admission.
In this review: Association Between Use of Rehabilitation in the Acute Care Hospital and Hospital Readmission or Mortality in Patients With Stroke (Archives of Physical Medicine and Rehabilitation, abstract only available for free at link)
Ageism pervades many institutions and sectors of society, including those providing health and social care, the workplace, the media and the legal system.
Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) directed toward people on the basis of their age. It can be institutional, interpersonal or self-directed.
To start a conversation around this, the World Health Organization has developed a Global Report on Ageism, as well as several resources, social media graphics, videos and tools.
Medicare’s free, official “What’s covered” app delivers accurate cost and coverage information right on your mobile device. Now you can quickly see whether Medicare covers your service in the doctor’s office, the hospital, or anywhere else you use your phone. The only official U.S. government Medicare app, “What’s Covered” helps you understand the health care coverage offered by Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
“What’s Covered” is available for free on both the App Store (https://itunes.apple.com/us/app/whats-covered/id1444143600?mt=8) and Google Play (https://play.google.com/store/apps/details?id=gov.medicare.coverage). Search for “What’s covered” or “Medicare” and download the app to your mobile device. Once “What’s covered” is installed, you can use it to get reliable Medicare information even when you’re offline.
As the U.S. health care system continues to struggle with a pandemic and its fallout, CMS keeps IRF payment changes relatively minimal.
In this review: Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2022 and Updates to the IRF Quality Reporting Program (proposed rule) Effective date: Oct. 1, 2021
The study of 1.4 million Medicare patients finds differing patient needs, but a consistent result: more therapy = better outcomes.
Amid regulatory pressures to move closer to a one-size-fits-all payment system across postacute care settings, a massive new study sponsored by APTA and the American Occupational Therapy Association is calling for a more careful approach. The analysis of 1.4 million episodes of rehab in skilled nursing facilities, inpatient rehab facilities, and home health agencies found that while rehab is strongly associated with significant improvements in function no matter the postacute setting, actual patient needs demand care that’s more tailored to each setting. Bottom line: Rehab works best when it can be adapted to the care environment and individual patients.