Posted on 05.17.18 by Cindy Hudson, B.S./OTR-L, RAC-CT, CHC
With the permanent repeal of the therapy caps late this past winter, residents, providers and therapists can all breath a sigh of relief. We can now consistently provide medically necessary interventions for those who need it. While this is good news, consumers and providers alike need to be aware that Medicare audits of therapy services have not gone away. Therapists always have been and will continue to be monitored to ensure they are providing skilled, medically indicated therapy serivces. Arbor Rehabilitation carefully reviews each of our teams to ensure all regualtory standards related to serivce delivery are met. We fully understand and educate our therapists that this is not an open invitation for the abuse of the system which created the need for the caps in the first place! Internal audits at Arbor Rehab are on-going to ensure high quality, skilled and medically necessary therapy is provided to all of our residents!
On April 27, 2018, CMS announced that they are replacing the RCS-1 system with a revised payment model called the Patient Driven Payment Model (PDPM). As the name implies, the focus will be on patient needs with a de- emphasis on therapy and an increased focus on nursing care per resident diagnosis. Therapy minutes will no longer dictate the payment per patient. Payment will be based on a Case Mix Index per their diagnosis and co- morbidities. The MDS will become greatly simplified with only a 5 day and Dischargre assessment required. In the event of a significant change in patient status, an Interim Payment Assessment may be completed. PDPM will be less subjective and more clincially based. Striking the balance of meeting the resident's clincial needs with the facility's need for profitability under this new model will be a challenge. At Arbor Rehab, we believe that honest communication and a shared desire for maximum resident outcomes will enable everyone to be successful in the days to come!