Transitioning to PDPM and PDGM: OT Students and New Practitioners Need More Support

By Jessica Golding, OTS; and & Sydney Chervenic, OTS

The shift from fee-for-service payment models to value-based payment models, such as Medicare’s Patient-Driven Payment Model (PDPM) in skilled nursing facilities (SNFs) and Patient-Driven Grouping Model (PDGM) in home health, is changing the occupational therapy profession (see resources below for more information about these changes). OT students entering the workforce may have difficulty finding quality full-time positions in these settings at their anticipated salary level as facilities try to maintain a profit during the PDPM/PDGM shift. New graduates, already stressed with the learning curve of being a new practitioner, developing their OT toolkit of interventions, and learning their facility’s billing procedures, are now also challenged to navigate new payment models.

It is important for current OT students and new practitioners to become more educated regarding PDPM/PDGM in order to better understand the potential implications for themselves, their clients, and their practice setting. To learn how new payment models are impacting new OT practitioners and OT students, we surveyed 15 recent graduates from Towson University and 39 current OT students at Towson University about their knowledge of PDPM/PDGM and what they wanted to learn. New OT practitioners discussed how PDPM/PDGM has already affected them:

• “Home health and PDGM has been a nightmare. With PDGM, home health companies are no longer being reimbursement per visit, so they strongly encourage you to do only 3x a week for 1 week, then taper to 2x a week, and 1x a week. [The] issue is patients require a higher frequency for longer. Recently, I have had to really advocate for my patients and stand my ground.”
• “At my SNF, we have been required to do at least one concurrent treatment a day and one group treatment a week.”
• “I had to utilize a health care consultant firm in order to find preferred employment because many seasoned therapists had lost their jobs to PDPM rollouts.”

Current OT students are also affected by this payment model shift. Students may have fewer opportunities for fieldwork experiences in SNFs or home health settings. SNFs may not have enough clinicians able or willing to supervise students, and academic programs may be wary of placing students in a setting so affected by health care industry changes. Among the OT students and new practitioners we surveyed, 53% of OT students and 47% of new OT practitioners were unsure how PDPM/PDGM may affect them.

What Current OT Students and New Practitioners Need to Know

For the OT student who wants to work in a SNF or home health setting, learning about these new payment models is a good place to start. It allows you to ask the right questions in a job interview or while practicing. Research your potential employer to help you find the place that is the right fit for you. AOTA Director of Quality, Julie Malloy, MOT, OTR/L, PMP, advises, “Before you work for an organization, find out about their policies, quality scores, productivity requirements, and how they determine how much therapy or which therapy they provide.” It is important to see that the facility is interested in building a long-term relationship with you and understands the role and value of OT practitioners.

Advocating for OT’s role in these settings is also vital under PDPM/PDGM. With the previous fee-for-service model, more therapy services meant more payment for facilities; organizations could easily see how OT helped their patients and bottom line. Now OTs may need to educate their organization about how OT benefits their quality scores and profits. “It’s no longer ‘more therapy means more payment,’ but OT can help your patients improve more quickly and can help to prevent them from being re-hospitalized,” says Malloy.

OT students and new practitioners should also be aware that payment models will continue to evolve. Malloy says, “You have to always be open and learning to understand how changes affect you and your patients. We are all lifelong students and if you look at it that way, the changes become easier to absorb.”

Call to Action for AOTA, OT Schools, and OT Students

Our survey showed that 87% of OT students want to know how PDPM/PDGM will affect them as a future practitioner, 67% of new practitioners want to know more about how PDPM/PDGM affects their current practice, and 73% of practitioners stated they could have been better prepared for the transition to PDPM/PDGM. OT students want more information on how PDPM/PDGM affects practicing clinicians, the reasoning behind changes, how OTs can advocate to give clients the best therapy, and how it impacts the job market. New practitioners would like to be educated on how Medicare covers therapy services, the reasoning behind PDPM/PDGM, and whether employers should be responsible for disseminating information to OT practitioners. Our survey shows there is a clear desire for more PDPM/PDGM education and resources targeted toward current OT students and new practitioners.

AOTA, as the largest professional organization of OT practitioners and students in the U.S., is in a unique position to disseminate resources on PDPM/PDGM. AOTA has created a webpage dedicated to Volume to Value and has many resources for both PDPM and PDGM (see resource below). Occupational therapy education programs also have a role in educating their students on the change from fee-for-service to value-based payment programs. “Information about the different payment models is really important to learn as a student so as you move out into the workforce you know what’s out there, what to expect, and what questions to ask,” says Malloy. With their strong ability to access OT students, AOTA and OT education programs have the opportunity to make the largest impact by providing vital support for students and new practitioners in the transition to value-based payment models.

OT students also can take an active role in learning more about PDPM/PDGM by bringing their interest in PDPM/PDGM to their professors, hosting a Boardroom to Classroom session with AOTA, or dedicating a SOTA meeting to learning more about these changes.

For more information on this topic, please see AOTA’s PDPM and PDGM resources most applicable to current OT students and new grads:

• aota.org/value provides information and resources regarding Volume to Value
• PDPM resources, including several recorded webinars and specialty conference resources
• PDGM resources, including a recorded webinar with CMS staff and specialty conference resources
• CommunOT to hear from OT practitioners about their current experience
• OT SNF and Home Health Evaluation Checklist & Quality Measures
• Considerations OTs should make for group, concurrent, and individual therapy  

Jessica Golding, OTS, is a second-year master’s student in Occupational Therapy at Towson University. During her time in the program, Jessica represented Towson’s Student Occupational Therapy Association as the Assembly of Student Delegates representative, co-founded the Towson chapter of the Coalition of Occupational Therapy Advocates for Diversity, and is a member of Pi Theta Epsilon. Jessica has a special interest in pediatrics and is excited to see where her future career in occupational therapy takes her.

Sydney Chervenic, OTS,is a second-year student at Towson University pursuing her master's degree in Occupational Therapy. During her time at Towson she has represented her class as a member of the Student Advisory Board and was selected to participate in the Student Conclave of Fall 2018. In addition, she has special interests in neuroscience and hand therapy and hopes to earn a fellowship in the future of either specialty. Sydney is excited to continue her journey and cannot wait to become a practicing occupational therapist.