Abstract
Objective
The Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing
Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision
of intensive physical and occupational therapy, however, there is concern that declines
in therapy staffing may negatively impact patient outcomes. This study aimed to characterize
the SNF industry response to PDPM in terms of therapy staffing.
Design
Segmented regression interrupted time series.
Setting and Participants
15,432 SNFs in the United States.
Methods
Using SNF Payroll Based Journal data from January 1, 2019, through March 31, 2020,
we calculated national weekly averages of therapy staffing minutes per patient-day
for all therapy staff and for subgroups of physical and occupational therapists, therapy
assistants, contract staff, and in-house employees. We used interrupted time series
regression to estimate immediate and gradual effects of PDPM implementation.
Results
Total therapy staffing minutes per patient-day declined by 5.5% in the week immediately
following PDPM implementation (P < .001), and the trend experienced an additional decline of 0.2% per week for the
first 6 months after PDPM compared with the negative pre-PDPM baseline trend (P < .001), for a 14.7% total decline by the end of March 2020. Physical and occupational
therapy disciplines experienced similar immediate and gradual declines in staffing.
Assistant and contract staffing reductions were larger than for therapist and in-house
employees, respectively. All subgroups except for assistants and contract staff experienced
significantly steeper declines in staffing trends compared with pre-PDPM trends.
Conclusions and Implications
SNFs appeared to have responded to PDPM with both immediate and gradual reductions
in therapy staffing, with an average decline of 80 therapy staffing minutes over the
average patient stay. Assistant and contract staff experienced the largest immediate
declines. Therapy staffing and quality outcomes require ongoing monitoring to ensure
staffing reductions do not have negative implications for patients.
Keywords
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Article info
Publication history
Published online: May 06, 2021
Footnotes
This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $601,188 with zero percentage financed with nongovernmental sources. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US Government. For more information, please visit HRSA.gov. https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding.
This research was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG065371. This content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute on Aging.
The authors declare no conflicts of interest.
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