Therapy MUST Show Value Beyond Visits

The data about SNF and Home Health therapy utilization from part 1 of this blog (Part I click Here) can be very frustrating to read. Considering that every one of us IS essentially the payer source for these services (if you aren’t sure about that – go look at your last paycheck deduction that went to Medicare), we can see with disturbing clarity that payment methodology does impact the delivery of services. An individual provider may be adamant that this has never been the philosophy of the organization and that “we don't do that here” but enough of it happens on an industry level that the trends are hard to dismiss.
 
MedPac recently released the 2016 report for Home Health Care Services and once again we see the frustration over the ongoing relationship between therapy visits and reimbursement:

• Recommendation: “The Congress should direct the Secretary to eliminate the payment update for 2017 and implement a two-year rebasing of the payment system beginning in 2018. The Congress should direct the Secretary to revise the prospective payment system to eliminate the use of therapy visits as a factor in payment determinations, concurrent with rebasing. “ This was supported by a unanimous vote.

 
Some will say that this is not a “new” recommendation with respect to the therapy visits as it has been a recurrent theme for several years BUT this one put a target of 2018 in the mix. Looking at other CMS initiatives such as the move from quantity to quality there has been an influx of expedited target dates – less “some day we should” and more “by this time we will” get things done. The push for changes is not limited to Home Health therapy. In a statement released by CMS Dr. Shantanu Agrawal, Deputy Administration for Program Integrity says, “CMS strives to ensure that patient need, rather than payment system incentives, are driving the provision of therapy services.  “These concerns have prompted us to refer this issue to the Recovery Auditor Contractors (RAC) for further investigation, and our hope is that data transparency will facilitate real changes.”
 
The response to this by some has been to lay the blame at the feet of the SNFs and Home Health Agencies as entities. I have heard the comment “If therapists were leading these organizations than none of this would happen”. This have given me significant pause. As therapists, we have to acknowledge that licensed members of our own professions are providing therapy minutes or visits in question for BOTH settings. Therapists are signing off on the care plan inclusive of frequency and duration. The responsible party at the end of the day is the THERAPIST no matter what pressure we may have been placed under regarding the decisions made. Continuing to follow along and do nothing makes us complicit and does not absolve us from accountability. I do mean US in this conversation because our future is being impacted across the board by issues such as these. Silence is seen as agreement. We cannot sit by and do nothing.

Cindy Krafft, April 11, 2016

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