Creating the Distinction between Individual and Individualized Care under PDPM

Symbria Vice President Rehab, Linda Kolleng

Individuals, in planning for their future, put money into retirement funds and savings accounts to ensure that there are funds for the time when their individual earned income is less.  Some more financially astute individuals work with a financial planner to create a comprehensive plan that considers the unique aspects of their lives and create an individualized plan designed to support their specific goals and objectives to maintain their lifestyle as they earn less.

Deliberately managing money earned (revenue) and spending (cost) allows them to maintain an optimal level of living that is supported by their income and planned savings.

Over the last several years our government has implemented legislation designed to bring Medicare spending under control. An overarching reality is that the cost of proving services to Medicare Part A patients has become more than what we can afford. There are lots of acronyms representing value-based payment programs that the government has outlined (IMPACT, MACRA, VBP, QRP). All of them designed to link payment to quality. Achieving greater “value”, translates tomaintaining or improving outcomes at a reduced cost. All these legislated programs impact the providers and subsequently the rehabilitation organizations serving them.

iStock-1029077176 With the introduction of PDPM, the reintroduction of group and concurrent modes of therapy has provided a way of reducing the cost of providing therapy. Consequently, the way “some” patients will be receiving “some” of their treatment may change. The regulations under the Patient Driven Payment Model (PDPM) require that all Medicare Part A patients receive at least 75% of their treatment on an individual basis. Many will receive more than 75% of their treatment in one-to-one sessions with therapists because they do not meet clinical criteria for participation in a group or concurrent setting. As always, each patient will continue to have a comprehensive plan of care that is individualized for them based on their unique needs. While exclusively providing individual therapy was not a requirement under PPS/RUGs IV, it became the mode of therapy that most therapists provided, and providers preferred for their patient clients. Re-evaluating the benefits of exclusively individual therapy approaches in contrast to interdisciplinary individualized treatment approaches under PDPM is intriguing and can provide our therapists and industry with guidance that ultimately draws all of us nearer to reality. Providing value at reduced cost. Each patient has a primary reason for coming to a skilled nursing facility for rehabilitation and nursing care post-hospitalization, but they also have comorbidities, unique psychosocial situations, family constructs and other factors that must be considered if optimal outcomes are to be achieved. An individualized treatment program is one in which all the stakeholders collaborate to ensure that all the patient’s needs are considered as the plan is developed. Through this collaboration, various aspects of the patient’s recovery and restoration are addressed by an interdisciplinary team, comprised of members who support the patient as they prepare to move from the skilled nursing facility to home or other appropriate discharge level of living.

Individualized treatment requires involvement of nursing staff as participants in restoring functional skills through revitalized restorative nursing programs that augment the skilled therapy the patient receives. Individualized treatment includes the use of group and concurrent modes of therapy and will engage activities, social services and other facility staff more deliberately in supporting the patient’s psychosocial and emotional needs as they recover and prepare for transition to a lesser restrictive level of living. Individualized treatment may include a wellness/exercise regime, developed in collaboration with therapy and conducted by fitness personnel that supports patient goals and allows the patient to solidify functional improvement made during skilled treatment sessions.

<p">The role of therapy continues to be vital as these collaborative processes are further developed and honed. Interaction with physicians, nursing personnel, activities staff, social services and family members enables therapists to help guide a rehabilitation process that moves beyond the therapy clinic. Therapists must think beyond the individual treatment model of PPS/RUGs IV and become more involved in the comprehensive design of programming. This allows for a truly individualized approach to each patient’s care and provides them with the opportunity to enjoy an optimal level of living.


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