Dropping Therapy Utilization May Leave Seniors at Risk During COVID-19 Crisis

The implementation of the Patient-Driven Groupings Model (PDGM) has caused some home health providers to cut back on therapy utilization. But prehabilitation could have a positive impact during the ongoing COVID-19 pandemic, experts argue.

While trying to navigate PDGM’s fundamental changes to therapy visits and reimbursement, many home health providers made wholesale changes to their therapy strategy.

Since the launch of PDGM, for example, there has been a mix of staff layoffs and visit reductions among some home health providers.

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In fact, 52% of providers said they saw PDGM forcing a decrease in therapy utilization, according to a survey conducted by Home Health Care News. In the context of COVID-19, some industry professionals have expressed concern around therapy services and non-essential visits continuing.

“I’ve been of the opinion that scaling back rehabilitation as a pure response to PDGM without any evidence supporting that scale back is likely to result in poor functional outcomes for patients,” Dr. Jason Falvey, a post-doctoral fellow at the Yale University School of Medicine, told HHCN. “I think dropping therapy utilization leaves our home-bound older adults more vulnerable to the adverse impacts of something like a pandemic.”

Amid the coronavirus outbreak, prehabilitation — interventions that take place prior to a physiologic stressor — has the potential to make a major difference, he noted.

Historically, the concept of prehabilitation has been medically focused on making patients more resilient to the impact of a surgical procedure or cancer treatment, according to Falvey. But the same notion could apply to resiliency in the face of COVID-19.

“With the pandemic, obviously, there isn’t that much evidence for strengthening and resiliency, but if you follow the logic, people that are able to build up muscle mass and aerobic capacity are probably less vulnerable to the effects of pulmonary illness,” he said.

Both therapy and prehabilitation could also play a valuable role in lowering hospital admissions at a time when over-capacity issues continue to be a major concern.

Based on current numbers, if COVID-19 infected 40% of the adult population in a six-month period, there would be a capacity gap of nearly 1.4 million in-patient hospital beds, according to an analysis published by Health Affairs.

One to two weeks of weekly physical therapy sessions can help lower the likelihood of re-hospitalization for older adults by up to 82% in a 60-day period, according to a 2019 study published in the Journal of the American Medical Directors Association.

“Protecting hospital utilization and trying to keep hospital beds free for a surge of patients coming in with COVID-19 related illness is important, and something that I think therapy services in the home can have a really strong impact on,” Falvey said.

As regulators continue to crack down on the administering of what are considered “non-essential” care services, therapy still factors in, according to Falvey.

“Universally, physical therapy services and home care, in particular, have been classified as essential services,” Falvey said. “Now, there are internal discussions between all of us, as to how we can mitigate risk for vulnerable patients. We have had conversations on how to minimize face to face visits.”

One solution that has seen the spotlight recently is the wider use of telehealth services.

In response to the pandemic, the Centers for Medicare & Medicaid Services (CMS) has moved to make telehealth tools more accessible.

“For patients discharging home who are COVID-positive, telehealth is a viable and valuable option for the entirety of their care while still infectious to help address disability and readmission risk,” Falvey said. “For other patients, telehealth should be used as an adjunctive strategy to supplement face to face care to minimize risk.”

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