Medicare seeks to reward long-term care facilities for providing both efficient and high-quality care. In fact, the government organization provided skilled nursing facilities with $28.8 billion in funding in 2013. But what is the best way to measure care delivery? A recent article in the Wall Street Journal brought to light Medicare’s current incentive system, which provides funding based on the number of minutes of therapy logged each week at a facility — including physical, occupational and speech therapy. The article questions if this system is working and whether it should be revised. The answer? Maybe.
The ultrahigh therapy model
Facilities are classified as offering ultrahigh therapy when they log a minimum of 720 minutes of therapy per week. Along with this ranking comes the highest level of Medicare funding, helping incentivize facilities to meet this high level of care. If patients don’t meet the ultrahigh mark, other increments of therapy follow, with fewer corresponding payments for fewer minutes of therapy. But The Wall Street Journal article begs the question: What if patients don’t need this much care; or worse, what if excessive therapy is actually detrimental? This can present a major concern in a profession that exists to help patients heal.
Response of the American Physical Therapy Association
Therapists can be challenged by situations where they are expected to deliver high volumes of care — having more to do with the well-being of the facility than the well-being of the patient. APTA President, Sharon L. Dunn, PT, Ph.D., OCS responded to this phenomenon in a Wall Street Journal opinion piece. Ms. Dunn stated: “Patient-care decisions should be made by clinicians in accordance with their clinical judgment and ultimate professional responsibility to their patients. Value — the outcome of care relative to the cost or resources needed to provide that care — should be the primary indicator of performance.” In other words, therapists should be providing care to the extent evidenced by the patient’s needs, and not to meet a minimum volume goal. In fact, to do so can go against licensure laws.
What’s to come for Medicare funding
The benefits of therapy to patient recovery have been well documented, and physical, occupational and speech therapy are all important on a patient’s road to recovery. In response to the controversy over Medicare billing, a collaboration between the APTA, American Occupational Therapy Association (AOTA) and American Speech-Language-Hearing Association (ASHA) is currently underway. In closely examining the current policy of billing for volume of therapy and the critical role of the therapist in patient care, this issue is sure to resurface. Stay tuned for upcoming developments and possible billing changes.
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