Home health care therapy layoffs linked to the Patient-Driven Groupings Model (PDGM) may not be as widespread as most industry insiders feared, new findings suggest.
But 2020 is still young — and there’s no telling what the rest of the year will bring for the industry’s physical, occupational and speech therapists now that the coronavirus has grown into an international public health emergency.
Going into this year, many believed home health providers would drastically alter their therapy strategies to better suit PDGM’s framework, which bases therapy reimbursement on patient characteristics rather than the sheer volume of services delivered. Those expectations intensified after a June survey conducted by the National Association for Home Care & Hospice (NAHC) revealed that nearly half of home health providers planned to cut therapy utilization in 2020.
Reports of skilled nursing operators laying off thousands of PTs, OTs and SLPs following the Oct. 1 implementation of the Patient-Driven Payment Model (PDPM) fueled home health therapy predictions even further.
“I know, as a therapist, my brothers and sisters in the therapy universe get a little antsy … thinking that [PDGM] is going to be the death knell for therapy and that therapists are all going to lose their jobs,” Cindy Krafft, co-founder of consulting firm Kornetti & Krafft Health Care Solutions, said during a NAHC webinar.
To better gauge PDGM’s impact on therapy, Home Health Care News recently surveyed more than 480 Medicare-certified home health professionals, asking them to weigh in on everything from direct layoffs and utilization cuts at their organizations, to salary reductions and conversions to part-time status. With support from Homecare Homebase, HHCN conducted the survey online throughout February and early March.
When it comes to direct layoffs, just 24% of the home health professionals surveyed said their organizations have let therapy staff go because of PDGM. Among those who did report layoffs, the majority said their organizations made cuts of 20% or less.
A similarly small proportion of the respondents said their organizations have slashed therapists’ salaries or converted full-time jobs to part-time positions.
While layoffs, salary cuts and job restructuring may not be rampant, there does appear to be a substantial drop in overall therapy utilization, according to the survey.
About one-third of the surveyed home health professionals said their organization’s therapy utilization has decreased by at least 15% since the Jan. 1 implementation of PDGM, with another 22% reporting a drop in utilization greater than that amount.
About 45% of respondents told HHCN that therapy utilization at their organizations has stayed the same — or increased — since PDGM’s Jan. 1 implementation.
Detrimental to patient care
Moorestown, New Jersey-based Bayada Home Health Care is among the organizations that have avoided knee-jerk therapy reactions because of PDGM.
Instead of avoiding therapy services entirely, Bayada has aimed to foster more clinical collaboration, giving PTs, OTs and SLPs more chances to work alongside nurses in “clinical huddles.”
The goal of the huddles: to make sure each patient receives the right mix of services in the most efficient way possible to achieve the best-possible health outcome.
“This has to be something focused on, ‘How do we get this patient better?’” Mike Johnson, Bayada’s home health practice leader, told HHCN at the Home Care 100 conference in January. “And then the other piece is getting all the clinicians involved, so everyone feels like they’re part of the team.”
Bayada has no plans for wholesale layoffs of therapists, Johnson noted at the time.
“It’s not part of the plan,” he said.
Executives from other large home health providers have echoed similar remarks.
“We’ve had zero layoffs of therapists. We’ve had zero changes in compensation to our therapy, our visit approach. Any of that,” April Anthony, CEO of Encompass Health’s (NYSE: EHC) home health and hospice segment, previously told HHCN. “We really feel like the whole therapy-behavior change is over-cooked.”
While few HHCN survey respondents said their organizations are cutting therapy jobs or salaries, a majority did say they generally view PDGM and its therapy changes as detrimental to patient care.
Although Bayada isn’t drastically altering its therapy strategy, Johnson said he understands the therapy-induced job anxiety.
In fact, it’s something he lived through himself during the transition to the Prospective Payment System (PPS).
“I am a physical therapist,” he said. “I was here 20 years ago when something similar went through with PPS. It really felt like the end of the world as we knew it, even though, in the end, it didn’t directly affect me.”
A different narrative
HHCN’s recent survey paints a relatively healthy picture of home health therapy services in the post-PDGM world.
Separate survey efforts from other organizations tell a very different story, however.
The American Occupational Therapy Association (AOTA), for example, has been conducting a PDGM therapy survey since the start of the year. As of March 11, the trade association’s survey included feedback from at least 685 OT professionals.
Of those respondents, 82% said they’ve experienced a requirement to reduce the number of home health occupational therapy visits furnished. Another 39% said they’ve witnessed a reduction in the number of OTs at their organization, either due to layoffs or reduced hours.
Additionally, more than 40% said they’ve experienced changes to occupational therapy practice patterns, including home health agencies refusing to fulfill physician orders or forcing OTs to stretch out services to provide care into a second 30-day episode.
“I have been practicing for about 30 years and have never experienced something like this,” one OT told HHCN in an email on April 8. “It is disheartening. [The] changes from corporations really show that the bottom line is what is most important.”
As home health providers respond to coronavirus challenges, some may opt to shift their therapy strategies yet again.
Previous research has shown that proactive pre-rehabilitation services can make patients more resilient while battling cancer or undergoing surgical procedures.
Some experts believe pre-rehab can also make a difference with the coronavirus.
“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,” Dr. Jason Falvey, a post-doctoral fellow at the Yale University School of Medicine, previously told HHCN.
In particular, the coronavirus national emergency may specifically prompt some providers to change how they handle OTs.
The Centers for Medicare & Medicaid Services (CMS) announced earlier this month that it was granting occupational therapists the ability to conduct initial and comprehensive home health assessments under Medicare rules.
“When occupational therapists are not permitted to open cases, there is a chance that vital occupational therapy services may not be utilized for patients who need services in the home to improve or maintain function,” Sherry Keramidas, the organization’s executive director, said in a statement. “AOTA continues to believe that occupational therapy may be the most appropriate discipline to start a case, given that occupational therapists assess and evaluate the patient’s home environment, evaluate functional status, identify possible safety issues, and identify other needs and strategies immediately, such daily management of chronic conditions and adherence to daily medication administration routines.”
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