Payment Models in Post-Acute OT

Spending time in research can deliver the humbling, but needed, reminder that not all therapy leads to clear value for our clients.

For example, in the United States, we can now see that in the 2010s therapy was being delivered in skilled nursing facilities (SNFs)—beyond what was helpful for clients.

Part of the problem was the fee-for-service payment model that incentivized skilled nursing facilities to deliver high quantities of therapy minutes to as many patients as possible. (More therapy equaled more money.)

The research article that we will explore in this one hour course, shows us the humbling data behind this problem. And, it reminds us of why the transition to value-based care continues to happen. The authors specifically look at data around post-acute hip fracture rehab, and compare fee-for-service Medicare versus Medicare Advantage (which is a value-based care program.)

To help us make sense of the changing therapy landscape, we are thrilled to welcome Clarice Grote, MS, OTR/L, who is an innovative advocate for occupational therapy and an expert on Medicare post-acute care policy. Clarice will help us understand how this research applies to your individual practice.

1. You will be able to identify the different financial incentives related to therapy in fee-for-service models versus value-based care.

2. You will be able to describe challenges for occupational therapists in value-based care payment models.

• Intro

• Breakdown and analysis of journal article

  • Quick overview of Medicare

  • The difference in incentives for therapy in fee-for-service versus value based care

  • What was the main question driving this research?

  • What were the authors’ methods?

  • What outcomes were they digging for?

  • What were the results?

  • What did the authors discuss?

  • What did the authors conclude?

  • Takeaways for OT Practitioners

• Discussion on practical implications for OTs (with guest Clarice Grote)

  1. Can you tell us about how you found OT and what made you become interested in policy?

  2. Why is it important to understand payment models?

  3. Why is it good for all OTs, even those working outside Medicare and the US, to be following research like this article?

  4. Were you surprised by the research findings, like the authors were?

  5. What do you think the implications are for OTs?

  6. Value based care seems good for our patients, but it shifts therapy from being a revenue driver to a revenue taker. What does this mean for OTs?

  7. How do you think OT can prepare for the payment models of the future?

  8. Are there any innovative payment models you would like to see OTs embracing?

  9. For OTs who are interested in learning more and staying up to date about payment models and legislation, where do you recommend they start?

  10. Where would you like to see OT in 5-10 years when it comes to policy and payment models?

Primary

• Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data

Additional

• Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service

• Association between the Patient Driven Payment model and therapy utilization and patient outcomes in US skilled nursing facilities

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic.

Speaker interests: Clarice Grote is founder and CEO of Amplify OT, which sells Medicare policy education to occupational therapy practitioners. She also contracts with the American Occupational Therapy Association on policy issues.