Abstract
This scoping review aims to enhance OTs’ knowledge of how policy affects therapy practice through investigation of value-based Medicare reimbursement’s effects on therapy provision, staffing, and patient outcomes in skilled nursing and home health.
Primary Author and Speaker: Caitlin G. Dobson
Contributing Authors: Alison M. Cogan
Value-based models (VBMs) of Medicare reimbursement aim to reduce unnecessary therapy and improve client outcomes. Their nationwide implementation in skilled nursing (SNF) and home health (HH) began in 2019, and how they changed therapy provision, staffing, and outcomes is unclear. Prior VBMs in other settings overly penalized hospitals serving marginalized populations and rightsholders have questioned if the new models reduced medically necessary services. This study aims to examine the new VBMs’ effects on therapists and clients via descriptive method: a scoping review of peer-reviewed literature and published abstracts in Web of Science and PubMed from 2019 through January 12, 2024, using the VBMs as search terms (‘Patient Driven Groupings Model’ OR ‘Patient Driven Payment Model’). Eligible studies reported the models’ effects on therapy, staffing, or outcomes. Protocols, studies of prior VBMs, and studies anticipating the VBMs’ effects were excluded. Ten studies met inclusion criteria and reported decreased therapy staffing (n=6), decreased therapy time (n=4), reduced pay and benefits (n=2), higher productivity expectations of therapists (n=1), and conflicting reports on employers determining therapy frequency (n=2). Measured client outcomes in SNF were unchanged (n=2). HH therapists perceived clients as receiving less or lower quality therapy compared to pre-policy change (n=2). Despite decreased staffing, pay, benefits, and therapist control over productivity or therapy time, the VBMs’ affect on clients remains undetermined due to limited evidence. Outcomes were only reported in two studies and were unchanged. Future research may analyze whether outcomes across diagnoses, sociodemographic characteristics, and therapy settings changed post-VBM. SNF and HH therapists should practice with attention to quality of care following reimbursement reform, and seek education on Medicare guidelines on necessary services for clients requiring longer-term care.
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