As of October 1'st 2019, PDPM( Patient-Driven Payment Model) came into place in the nursing home setting. PDPM is how a facility is reimbursed for services from insurance. Before PDPM therapy was its own entity and a facility was provided a rate depending on the coverage and amount of minutes a patient tolerated provided by therapy. This new payment model groups nursing and therapy as one. The issue with this new system is that patients are no longer receiving therapy services like Occupational, Physical, or Speech services they require. The frequency of five times a week has been reduced to three times a week, sixty minute treatments have been cut to thirty-minute treatments, and individualized therapy is now a required group session. Instead of receiving therapy services, a skilled intervention, many facilities are implementing a restorative program six times a week into there daily documentation. By doing this, it will increase the capitalization of funds provided by PDPM. As long as a facility is providing two restorative programs a day for fifteen minutes, six days a week per CMS( The Centers for Medicare & Medicaid Services) regulations, the facility will qualify for more financial reimbursement. A restorative program was intended initially to provide a non-skill service; it's a maintenance program to prevent falls, declines, donning splints to prevent contractures. These programs are delivered when a patient is off of therapy services; it is implemented by a therapist. With the new payment model, this is now performed in tandem. Many facilities are incorporating the restorative program in with the documentation and daily care already provided, stating the services like ADL's ( activities of daily living such as dressing, brushing teeth and eating,) and ambulating( walking) to the bathroom are enough. These are everyday skills, and no other program is put in place. What benefit is the patient getting from this? The video intended to educate staff and patients on PDPM, about the restorative program displayed many therapeutic interventions. What is your take on the new PDPM restorative program? Do you see a bennifit? Did you know about the new restorative program in your facility? Are they billing for one?
References
Bonanni, D. R., Devers, G., Dezzi, K., Duerr, C., Durkin, M., Hernan, J., & Joyce, C. (2009). A dedicated approach to restorative nursing. Journal Of Gerontological Nursing, 35(1), 37–44. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=19227101&site=ehost-live
Chubb, L. (2018). Implementing restorative nursing. PPS Alert for Long-Term Care, 21(7), 10–12. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=130651114&site=ehost-live
Remsburg, R. E., Armacost, K. A., Radu, C., & Bennett, R. G. (2001). Impact of a Restorative Care Program in the Nursing Home. Educational Gerontology, 27(3/4), 261–280. https://doi.org/10.1080/036012701750194987
Rachael Plumley
Eng 422