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[Blog Series] Preparing for the Patient Driven Payment Model (PDPM): Week 3

July 05, 2018
Reimbursement By Zenobia Knight

Thank you for joining us for week 3 of our blog series, “Preparing for the Patient Driven Payment Model (PDPM).” This week we will review: Utilizing the Transdisciplinary Therapy Model in the Treatment of Older Adults.

PDPM_series Week 3-01

The Transdisciplinary Therapy Model combines skill and experience across various disciplines within the therapy setting. This model is practiced in developmental pediatrics, habilitation facilities, outpatient clinics, and school settings.

Healthcare delivery models must be revised to keep up with the increasing demands of

  • the growing geriatric population,
  • capitated rates,
  • bundled payments,
  • the Patient-Driven Payment Model (PDPM),
  • the increased commitment to quality outcomes, and
  • the escalating cost of healthcare.

The Medicare hospital insurance (Part A) trust fund solvency is a heavily debated topic.

Some argue that the fund is projected to deplete in 2029, while others insist that 2029 incoming payroll taxes plus other revenue will pay 88% of the costs. However, there is no dispute that we have a growing geriatric population which requires increased healthcare funding.  Whether you subscribe to the Medicare doomsday perspective or if you are optimistic about the Medicare trust fund, there is a consensus that managing healthcare costs is critical. 

The United States Census Bureau published an article titled,Older People Projected to Outnumber Children for First Time in U.S. History.” 

The article states by the year 2030, all baby boomers will be older than age 65.  Furthermore, “By 2035, there will be 78.0 million people 65 years and older compared to 76.4 million under the age of 18.”

Can the Transdisciplinary Therapy Model be utilized on a broad scale in the geriatric setting?

There are a few techniques to implement the Transdisciplinary Therapy Model. This blog article covers the process of one therapist (when indicated) providing most, if not all, of the required therapy interventions. Therapy evaluations are administered as needed by the appropriate discipline. If a transdisciplinary approach is applicable, then it must be decided which therapist(s) should provide the treatment for the identified deficits. 

This therapy model can be utilized without scope of practice issues or other regulatory concerns. Therapists must be willing to release what they consider their domain and view the patient more holistically

The RUG-IV payment model for the SNF is based on the utilization of services. 

If the patient is treated by 2-3 skilled therapy services 5 times a week for a minimum of 720 minutes, then the patient is placed in the Ultra Rehabilitation Resource Utilization Group (RUG). The current reimbursement for the SNF in Medicare Part A encourages the patient to be evaluated and treated immediately upon admission.

The PDPM facilitates the therapy team to be strategic and sensible concerning

  • disciplines to be evaluated,
  • disciplines to be treated,
  • the time of evaluation,
  • the time of treatment, and
  • the amount of skilled therapy provided.

At the same time there is a mandate for higher quality of care and better coordinated care, there is increasing concern how services for the elderly will be paid. The Transdisciplinary Therapy Model may be one method to control costs and yield good outcomes. 

Opportunities to explore this model in the geriatric setting include:

  • The PDPM
  • Various Bundled Payment Models
  • Reimbursement with Capitated Rates

The following is an example of the implementation of the transdisciplinary therapy approach in the geriatric setting: 

Consider a patient who has dense hemiplegia from a cerebrovascular accident (CVA).  The patient has severe mobility limitations, does not consistently track visual or auditory stimuli, and follows simple 1 step commands with only 20% accuracy.  During this time both physical therapy (PT) and occupational therapy (OT) are concerned with the patient attending to a task, following commands, tracking visual and auditory stimuli, head control, trunk control, seating and positioning, bed mobility, transfers, extremity and trunk range and strength. PT and OT evaluate the patient and the team decides which discipline should treat the patient. Suppose this patient also has a percutaneous endoscopic gastrostomy (PEG).  The speech therapy evaluation of this patient would determine if speech therapy is needed initially or if PT or OT could provide oral motor exercises until the patient follows directions sufficiently to participate in swallow therapy with the speech language pathologist.  Communication among disciplines is essential.

Another example of when the transdisciplinary therapy model may be appropriate is if both PT and OT are administered to the patient upon admission to the facility and the following occurs:

  • All PT goals were accomplished except for dynamic standing balance. In this example, physical therapy could discharge the patient.
  • OT continues to work on goals for dynamic standing balance as well as other instrumental activities of daily living.

Whether it is patients with joint replacements, patients with recent coronary artery bypass graft surgery, or the medically complex patient with urinary tract infection, chronic obstructive pulmonary disease, and Parkinson disease; this model can be applied.  Now is the time to fully explore the implementation of the Transdisciplinary Therapy Model in the rehabilitation of older adults. Contact one of our consultants today!


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