Home Health Providers Skimping on Therapy Will Likely Pay Steep Price

As the Patient-Driven Groupings Model (PDGM) nears, providers are still trying to figure out how they will navigate 2020’s uncharted territory. For many, there’s a temptation to gain ground by sharply cutting therapy utilization.

But that will likely hinder quality of care and cause some providers to pay a steep price.

“The minute we saw a payment model that ended the relationship between therapy visits and reimbursement, the question was, ‘What does this mean?’” Cindy Krafft, owner and founder of Kornetti & Krafft Health Care Solutions, said during a presentation at the National Association for Home Care & Hospice (NAHC) annual conference and expo in Seattle. “Some felt this was the ‘death knell’ for therapy, that therapy was going to [see a] fire-sale out of home health.”


Over the years, therapy visits have been a big reimbursement boost for home health providers. Under PDGM, therapy-heavy providers won’t be able to automatically drive payment this way; Instead, patient characteristics and outcomes will determine reimbursement.

As a result, many home health providers plan to scale back on therapy use. About 25% of providers that participated in a 2019 NAHC survey said they plan to reduce therapy utilization by more than 10% in 2020.

But the idea that indiscriminately cutting therapy visits is in compliance with the Centers for Medicare & Medicaid Services (CMS) is mistaken, according to Krafft.


“Can we stop the mantra that changing therapy utilization in home health is somehow at the behest of CMS and that PDGM is designed to reduce therapy,” Krafft said. “That’s a phrase we hear far too often. The position is [that] CMS disagrees that PDGM diminishes or devalues the clinical importance of therapy.”

Additionally, slashing therapy utilization could hurt downstream outcomes, according to Dr. Jason Falvey, a post-doctoral fellow at the Yale University School of Medicine.

“Decreasing therapy use might actually be providing reimbursement-centered care and not patient-centered care,” Falvey said at the NAHC conference. 

In general, home-based rehab services are poorly studied when it comes to readmission rates. Research studies about home-based care tend to focus on front-loading nursing visits or having eyes on patients for the first seven days, according to Falvey.

“When we think about rehab services and the impact on readmissions, I think we start with functional impairment,” he said. “Functional impairment is a really strong predictor for hospital readmissions. When you look at potentially preventable readmissions, that relationship is even stronger.”

A 2018 study of 1,300 home health patients found that people who used more than 2.3 visits of therapy on a weekly basis had 82% lower rates of hospital readmission compared to those who did not.

Therapy also improves multiple aspects of function, such as gait speed, muscle strength, balance, balance confidence and self-efficacy, according to Falvey.

Additionally, a 2011 study found that heart failure patients who utilized physical therapy saw significant functional improvements compared to those who didn’t.

Finding the balance under the upcoming payment overhaul could be tricky, but Falvey urges providers to move the number of therapy visits toward the middle in lieu of completely cutting therapy.

In other words: Providers should cautiously explore the great PDGM unknown before making concrete plans to completely shake up their entire operations.

“Under PDGM, underutilization of therapy may become a bigger problem than overutilization,” Falvey said. “If you short therapy on the front-end, you end up paying for it in the back-end.”

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