Group Therapy: The Answer to PDPM?

While the best patient care is always the chief goal, we as skilled nursing facilities (SNFs) are constantly looking for ways to streamline operations to protect the longevity of our businesses. If we have to close our doors, we can’t help anyone. And with the recent focus shift from volume-based to value-based care under the Patient-Driven Payment Model (PDPM), efficiency of care becomes that much more important.

One solution that could provide immense savings without sacrificing the quality of care is group and concurrent therapy. By maximizing our staff and resources in the right way, we could see some game-changing results. And while it’s important to note that there are new challenges here with COVID-19, there are still opportunities for successes under PDPM.

An Effective Way to Cut Costs

Before we go any further, let’s briefly cover why group and concurrent therapy can provide benefits under PDPM. As we’re no longer billing based on the number of therapy minutes provided but based on the needs and medical complexity of the patient, there are direct cost-savings when therapy minutes go down. By providing these treatment modes properly, we can deliver the same results while using fewer resources.

The Limits Imposed by CMS

Depending on the needs of the patient, shouldn’t we look to use group and concurrent therapy as much as possible? While, in theory, this sounds good for some patients, the Centers for Medicare & Medicaid Services (CMS) has imposed limits on group and concurrent therapy under PDPM.

Under the classic RUG-IV system, group therapy was already limited to 25% of therapy services, but there were no limits on concurrent therapy.¹ Under PDPM, the 25% limit is extended across the board to include group and concurrent therapy collectively.² The total combined minutes must be no more than 25% of the total therapy services rendered.

Patient Results and Quality of Care

So, is group and concurrent therapy the answer to PDPM? The answer always comes back to the quality of care. Is the patient getting the level of service they need to get better? Are we getting the results we want? If the answers to these questions aren’t resounding yesses, we could see issues.

• If the treatment isn’t working, we’ll need to provide additional and unexpected treatment that can be costly. Additionally, the Variable Per Diem Adjustment Factor, which helps determine reimbursement, goes down the longer the patient stays.³ This means that we’d be occupying a bed for a patient bringing in lower reimbursement.
• SNFs will need to justify all uses of group and concurrent therapy. While streamlining operations is the underlying driving force, the justification should focus on the increased benefit to the patient.

Some Tips For Success with Group and Concurrent Therapy

• Work closely with therapists, physicians, and staff to identify the best opportunities to maximize the benefits of group and concurrent therapy.
• Use data to identify trends of successes and areas of improvement with group and concurrent therapy. The more detailed the results tracking, the more we can fine-tune our operations.
• Closely monitor any regulatory changes or suggested best practices for group therapy in relation to COVID-19.

When utilized and maximized properly, group and concurrent therapy can deliver better results for our patients while helping to streamline our budgets and protect the longevity of our businesses.

Take the First Step Today

Learn how Optima Therapy for SNFs can help drive efficiencies and satisfy justification documentation with group and concurrent therapy through complete documentation, measurable outcomes, and extensive reporting and analytics.

1, 2, 3. CMS, SNF PPS: Patient Driven Payment Model, September 17, 2020.