A Change in Medicare Has Therapists Alarmed

Genesis HealthCare, one of the country’s largest providers of skilled nursing, has eliminated about 500 therapist positions since the Patient-Driven Payment Model took effect. “We have found that the appropriate use of group and concurrent therapy can actually be more efficacious than one-on-one therapy in many cases,” a spokesman for the company said in an email.

Maybe. A number of studies have shown that group therapy (in which several patients work on the same task) or concurrent therapy (where the patients work on different tasks) can indeed be helpful. But therapists have insisted that their clinical judgments, not the dictates of employers, should determine who gets what kind of therapy, and how much.

The Centers for Medicare and Medicaid Services acknowledged as much in its final rule adopting P.D.P.M.: “We agree that therapists are the most appropriate professionals to determine the mode of therapy a patient should receive and that professional judgment must be trusted and used” in nursing facilities.

Therapists contend that, instead, their judgments are being overridden. Alexander Zwick, a physical therapist at JDT Villa, a rehab facility in Lincoln Park, N.J., said that after Sept. 30, patients “were getting less therapy because people on the business side were coming between patients and professionals.”

“The time for the patients dropped drastically,” Mr. Zwick said, from an hour a day to 30 to 45 minutes: “Same patients, same diagnoses, different payment system.” (JDT declined to comment.)

Therapists have also reported that, where facilities have substantially reduced staffing, the workload of the remaining workers has become unmanageable.

Medicare officials have repeatedly said they will monitor the new system. “Significant changes in the amount of therapy provided” or “the manner in which it is delivered” could trigger reviews and policy changes, a Medicare spokesman said in an email.

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