At the outset of 2020 agency managers who were concerned about the effects of the Patient-Driven Groupings Model (PDGM) urged restraint for therapists who were scheduling home visits. Then, COVID-19 hit, unexpectedly shifting control of decisions about frequency back to therapists.

The Reduction Everyone Expected

The Centers for Medicare & Medicaid (CMS) designed PDGM as a payment overhaul that would also refocus the home health industry toward nursing. As a result, half of home health providers anticipated a decrease in therapy utilization in 2020, notes a report from Home Health Care News.

According to Cindy Krafft, owner and founder of Kornetti & Krafft Health Care Solutions, when the pandemic swept across the United States in March 2020, the utilization of home health physical therapy “…took a completely different hit with respect to trying to determine how to manage the initial crisis mode of saving lives and minimizing risk.”

Why It Didn’t Come

The arrival of COVID-19 had a transformative effect on how many home health agencies had prepared for PDGM.

“At the beginning of the year with PDGM, we were being questioned when we put visits at twice per week for four weeks, for instance, or three times per week for four weeks,” Monique Caruth, DPT, observed during a Home HealthCare News webinar. Caruth is CEO of Fyzio4u Rehab Staffing Group, and is the southern district chair of the Maryland’s American Physical Therapy Association (APTA) organization

“We had clinical managers sending back messages saying, ‘We have to be careful because of PDGM.’ And then COVID hit,” Caruth says. “Then it went back to giving the therapist control of determining frequency.”

Frequency and Deconditioned Patients

The importance of providing adequate physical therapy services is underscored by a study published in the June 2019 issue of the Journal of Post-Acute and Long-Term Care Medicine. The study found one to two weekly physical therapy sessions can reduce the probability of rehospitalization among older adults by as much as 82% within a 60-day period.

The structure of PDGM, however, led rehab managers to be judicious about the frequency of therapy provided. Making the problem worse is that, to limit the spread of COVID-19, some home health agencies wanted to reduce the number of visits to as little as one in-person visit and one telehealth visit. Caruth objected to that approach.

“I didn’t find that very accommodating for patients who were highly deconditioned,” Caruth says in an interview with Home Health Care News. “So I would base my frequency or recommend that all clinicians based their frequency on how the patient presented at the time of the evaluation,” she adds.