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IF THERAPY MINUTES AREN’T DRIVING MY REIMBURSEMENT UNDER PDPM, IS THERE STILL A NEED FOR THERAPY?

Updated: Oct 9, 2019

PDPM, the newly finalized payment system for Medicare Part A patients will base reimbursement on the clinical complexity of a patient and the treatments required during the course of stay as opposed to the volume of services delivered. This has many providers asking, “Is therapy still important?”

The short answer is, ABSOLUTELY. 


Skilled patients and acute referral sources seek out qualified SNFs based on their short term rehab expertise and quality outcomes.  Take away or diminish rehab, and you will most certainly shrink your census and referrals. Clinical outcomes will suffer and your Quality Measures and Star Rating could be negatively affected. Reducing therapy will certainly increase the risk of readmission which will decrease revenue under the new VBP penalties. But the other overarching reason that therapy utilization should continue is because CMS has sternly warned, they will be monitoring this!  The current rates for PDPM were developed based on past utilization trends.  SNF providers would do well to continue along the current course as it pertains to therapy under PDPM. If typical utilization trends change future reimbursement could be considered for reduction. Those key therapy variables that will be under the microscope include; Changes in volume and intensity of therapy services, compliance with group and concurrent limits, increase in the use of mechanically altered diets and over-utilization of the cognitive impairment classifier.


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