04/01/2020
This is something I have been doing a lot of lately - massive face-palming.
Why?
Because I repeatedly see comments from therapists that say something like this...
"Since PDPM, my boss has told me that I can only provide _______ minutes of care..."
"Since PDGM, my boss is saying all therapists must provide ______ number of therapy visits..."
To this I say a resounding "NO, NO, AND NO!".
Do yourself a favor:
If you work in a SNF, search for the Medicare Benefit Policy Manual, chapter 8.
If in home health, chapter 7.
Do a word search for "individualized" and read everything associated with that word and the term "care plan".
Will you find ANYTHING which limits minutes or visits to a cookie-cutter approach to therapy careplanning? NOT AT ALL.
There are 4 people in the general group of those that determine the careplan - the doctor, the patient, and you. Now, I said 4, because third party payers have something to say about this, but notice who is not mentioned - YOUR BOSS. Your boss doesn't know the patient, didn't evaluate the patient, didn't inform the patient of the careplan, didn't collaborate with the MD to get orders...nothing.
When Medicare was getting ready to roll out PDPM and PDGM, they built into these systems opportunities for companies doing the right thing to make money as a net sum gain. This meant that there would be outliers, patients where you might not make money on, but there are ways to capture additional costs in the MDS and OASIS assessments to help companies DOING THE RIGHT THING not suffer losses. Medicare also is constantly assessing the fairness of these systems of payment and will make adjustments in the future.
By artificially lowering how much therapy will be provided to medically complex patients, companies are sending a message to Medicare that patients can get by with less therapy, even though this message will likely, in most cases, be untrue.
You have a choice:
1) Capitulate to cookie-cutter approach to care artificially imposed by people who have no part in the careplan OR
2) Stand up and tell your bosses that you will be providing, in the most cost-effective way you can, the specific care that your specific patient needs.
Please start doing the second option - my head hurts from all the face-palming!
