Changes in Therapy Utilization at Skilled Nursing Facilities Under Medicare's Patient Driven Payment Model

Area of Science:

• Healthcare Reimbursement Models
• Geriatric Rehabilitation
• Skilled Nursing Facility Care

Background:

• The Patient Driven Payment Model (PDPM) shifted SNF reimbursement from service volume to patient characteristics.
• Understanding PDPM's impact on therapy utilization and care quality is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate changes in occupational therapy (OT) and physical therapy (PT) utilization post-PDPM implementation.
• To assess the impact of PDPM on key quality indicators in SNFs.

Main Methods:

• A quasi-experimental design was used, analyzing Minimum Data Set data from 121 Oregon SNFs.
• Therapy minutes (individual and group OT/PT) and quality metrics were compared before and after PDPM for Medicare short stays.

Main Results:

• Individual OT and PT minutes decreased significantly (19.3% and 19.0%, respectively) post-PDPM.
• Group OT and PT minutes saw a slight increase.
• No significant changes were observed in SNF length of stay, community discharge rates, or 30-day readmissions.

Conclusions:

• SNFs adapted to PDPM by reducing individual therapy and increasing group therapy, without immediate negative effects on major quality indicators.
• The study highlights the need for further investigation into the differential effects of individual versus group therapy on SNF patient care quality.