PDPM crushing the subacute rehabilitation health care industry = massive layoffs, limited therapy for medicare patients

Regarding the up-coming PDPM payment driven payment method system begins October 1, 2019 Beginning 10/1/2019 If you or your loved one are going to a skilled rehabilitation nursing center for rehab and utilizing Medicare benefits, you must read this article. First and foremost, it’s Important for you to know that after leaving the hospital and before you arrive in rehab how much rehabilitation and therapy you will get is predetermined and severely limited by your federal government regardless of your rehabilitation needs or your health status. The new PDPM systems goal is to shorten the rehabilitation length of stay and decrease reimbursement cost for therapies. PDPM will achieve this by limiting your access to therapies in skilled rehab centers and by limiting how long you stay in a rehab center. This will be achieved by decreasing reimbursement for skilled rehabilitation making therapies a financial liability for the rehab centers providing them. In other words, they plan to take away much of the therapy that patients had received in the past utilizing their Medicare benefits under the PPS payment system. For example, with the new PDPM system your length of stay will be based on diagnosis codes that have end dates for reimbursement concerning rehab services. The projections for length of stay and reimbursement for rehab services are predetermined by PDPM. Notable for neurological pathologies such as stroke, CVA’s and head injuries PDPM projects a super low length of stay averaging just 14 days to recover. Additionally, the reimbursement to the rehab centers will decrease rapidly within the projected stay and will not change regardless of your therapy needs. For example, if you’re in need of 3 hours of therapy daily or just 30 minutes the payment is the same and continues to decrease within the length of stay making it financially impossible to provide the same level of therapy on day five as compared to one. Moreover, PDPM facilitates the patient’s early discharge home without considering current health conditions or functional mobility. Of course, this will place the rehab facility in severe financial distress. Moreover, some facilities are predicting the financial impact on the rehab center to be devastating with a greater than 40 % decrease in reimbursement for therapies provided after PDPM begins as compared to the current system called Medicare PPS that reimburses for therapies as they are provided on a continuum while at a skilled rehab center. This system was designed with the patient’s health status and therapeutic needs driving the reimbursement. Why PDPM ? Why are they doing this? Certainly not to improve your quality of care, but of course to save money! What is the problem with that? First of all, limiting your length of stay and reimbursement will certainly have a negative impact on your health your rehab and your recovery process. More importantly there is no system that can accurately predict how long it will take for you to recover from any diagnosis accurately. There are just too many other factors affecting your health and rehabilitation process. Moreover, some of the factors that cannot be predetermined accurately by PDPM is the patient’s current state of health at time of diagnosis, psychological, psychosocial, mental and emotional condition, unknown and known diagnosis, living conditions at home, and intellectual status. These factors all assist your health care team in determining when a patient’s health, functional mobility and physical safety have improved enough for their safe discharge home. For your health care team this is an ongoing process and is reassessed daily throughout the patient’s entire length of stay in the rehab center. This level of care cannot possibly be predicted or predetermined using an ICD10 code at time of illness. This PDPM system cannot be in the best interest of the patient their health or wellbeing. For example; the average stroke patient with weakness on one side or inability to move their arm/leg or trunk on one side of their body will take significantly more hours of skilled rehab to recover than the PDPM predetermined average of just 14 days. Stroke recovery is complicated and will require experienced therapist and specific rehab equipment that can only be provided in the rehab center. In other words, cannot be realistically achieved in your home without the much needed, therapeutic equipment and the limited allotted time home care therapy provides. This will drastically decrease the patient’s opportunity for rehab. Additionally, many of you will be forced to take your loved ones right back to the emergency room shortly after arriving home from the rehabilitation center. This will cost more money, extend care and will end up causing falls, broken bones and other related unnecessary health risk. This is a bad system first and foremost for the patient but for the loved ones as well. This will culminate into a poor quality of health care for all Medicare patients and is an unsafe high-risk health care practice. Moreover, PDPM will actually increase the overall cost of health care, extend patient recovery times, and cause multiple unnecessary readmission back to the hospital. Furthermore, putting your independence and your health at risk even though you’ve spent your entire life paying for the use of Medicare and the benefits of health care when you are of age. A similar ICD10 coding system for reimbursement and length of stay has been used in hospital for years. Which is why they mistakenly think it will work in the subacute rehab centers. Why won’t it work in rehab centers? First of all, hospitals by in a large do not practice skilled rehabilitation in any meaningful way. In fact, if the patient needs extended rehab the hospitals send the patient to the skilled rehabilitation center. Why do they send the patients to rehabilitation centers? This is done so the patient can achieve increased functional mobility and return home safely with a decreased risk for falls and other associated health risk. Moreover, it is it cost effective. The rehabilitation centers cost 90% less per night for a rehab bed as opposed to one night in a hospital bed. Why can the hospitals stay open and function under the ICD10 coding predetermined length of stay and reimbursement system and why won’t rehab centers be able to? Simply put because when it’s getting close to the predicted length of stay and the end of reimbursement for their services, they simply send the patients that need extended care to rehab centers. Therefore, if the patient cannot be safely discharged home they have a safe place to send them. The rehab center has only two choices. One is to send them home before the rehab process which is complete unsafely. The second choice is to continue rehab and absorb the enormous cost of the patient’s rehabilitation without adequate reimbursement which will surely put the rehab facilities out of business. There are no good choices for the patient or rehab center concerning the PDPM new payment system. Traditionally with the PPS payment system continued therapies have been based on the patients, current health status, cognition, emotional state, number of diagnoses, known and unknown, psychosocial status, current functional mobility, and current living condition. Using any other criteria as the PDPM system will result in sending the patient home to early and a quick readmission back to the hospital emergency room. The rehabilitation process is a complicated and requires communication and the effort of all parties involved from the caregivers such as doctors, nurses, therapist’s, family, friends, medical vendors and more, to ascertain when a patient is ready to safely return home. Which is the primary reason why PDPM will be disastrous for the patient’s health and rehabilitation. Here is why you will receive little to no rehab once PDPM arrives next year. This is the way PDPM will work! The hospital will provide a diagnosis code upon being discharged and admitted to a subacute nursing home. This process will etch in stone your length of stay and the amount of reimbursement that Medicare will provide for your recovery. This is true, regardless of your health status or actual therapy needs during your rehab process. In conclusion, simply put the rehab facility will not be able to provide an adequate amount of therapies for the patient to recover because of the financial restraints and predetermined projected length of stay for rehabilitation. The rehab center will have to provide therapy at a huge financial loss the way the PDPM is currently setup. This system will place physical, occupational and speech therapy in the expense category. In fact, therapies will become such a liability to the rehab center that therapies will have to be limited if the rehab center is to stay open. This is what ensures that the new PDPM federal government guide lines will be followed. In other words, they are removing any and all financial incentive to keeping the patient any longer than the ICD10 projected or predetermined stay dictates. The rehab facility will have no choice but to comply with the new PDPM system. They will have to be discharged home under the PDPM guide lines safely or not? At the risk of stating the obvious the bureaucrats believe that they can limit and take much of your rehab process and therapies away with this PDPM system and they will. This PDPM will begin on 10 /01/2019. We as therapist and patients should not let them go forward without having our voices heard. David J Bragga / Director of Rehab