What Happened to Therapy in Home Health?

We just returned from the National Association for Home Care Annual Conference in St. Louis, MO.  We were honored to present one of the 2 therapy-focused sessions at this conference.  Let that sink in for a moment, there were only 2 Therapy focused sessions in the entire NAHC Annual Conference.  We have attended more than 15 of these conferences. While therapy has historically been underrepresented, having only 2 sessions is an all-time low.

Why Has This Happened?

Let’s look at how Therapy has been reimbursed historically. Since the inception of PPS in 2000, via a visit count number, first as a financial bump for over 10 and then graduated financial return for 6, 14, and 20 visits.

However, as of 1/1/2020 and with the change of the payment system from HHRG rates to PDGM, visit counts are no longer driving therapy payments.  PDGM began the process of integrating therapy costs into reimbursement. However many agencies are implementing therapy as purely a cost since there is no longer a “financial incentive” to do a certain number of therapy visits.  We actually had a client reach out and ask how they could begin doing Maintenance Therapy without “hurting” the quality scores and causing financial harm to their agency.

We Are in New and Uncharted Waters

When Therapy is de-incentivized, it appears Therapy is being rationed and considered a very ancillary participant in Home Health. This is also likely why there was so little info or discussion around Therapy as part of the Home Health benefit during the conference this year.

This practice goes against a ton of research and data that demonstrates that Therapy is key to a patient’s independence and ability to stay in their home and out of higher-cost centers of care.

A Word of Caution

We would caution everyone who reads this blog against rationing any type of care in HH, particularly Therapy as it has been under extensive scrutiny for “gaming” and increasing visits to gain financially.

You might think that we, as therapists, believe the more therapy the better.  We do not.  We think therapy as well as all other services in Home Health, should be prescribed based on patient need.