Starting in Fiscal Year 2019 (October 1, 2018), as mandated in the FY2018 SNF PPS Final Rule, Skilled Nursing Facility (SNF) providers will begin a new Quality Reporting Program (QRP) in which they will be assessed on their performance with four new functional outcome measures (change in self-care score, change in mobility score, discharge self-care score, and discharge mobility score). In order to enable assessment of the functional outcome measures, CMS will be adding new Section GG items to the MDS on October 1, 2018. Initially, the only financial penalty associated with these new measures will be a 2% withhold of Med A payments based on failure to report at an 80% threshold of Med A stays. Beginning in FY 2020 (October 1 of 2019), facilities will be measured on their actual performance, with outcome incentives and penalties applied based on facility performance against established benchmarks for performance. The data collected between 10/1/18 and 12/31/18 will be used to inform payment bonus/penalty starting 10/1/19 (FY20). The data collection period will then move to a calendar year and the data from 1/1/19 to 12/31/19 will be used to inform payment starting 10/1/20 (FY21), and so on.
As the data collection period for the SNF QRP approaches, the goal for SNF providers is to optimize performance in functional outcomes to minimize the risk of financial penalties in 2019.
ACP is an ideal partner to help achieve goal, based on proven performance in generating superior functional gains in self-care and mobility outcomes.
To help objectively quantify the impact of comprehensive clinical programming augmented by physical agent modalities, ACP contracted with The Moran Company in 2016 to conduct an independent analysis of functional outcomes related to the delivery of physical and occupational therapy in skilled nursing facilities with a focus on specific biophysical agents – diathermy, electrical stimulation, and ultrasound - supported by ACP training and program support.
To help objectively quantify the impact of comprehensive clinical programming augmented by physical agent modalities, ACP contracted with The Moran Company in 2016 to conduct an independent analysis of functional outcomes related to the delivery of physical and occupational therapy is skilled nursing facilities with a focus on specific biophysical agents – diathermy, electrical stimulation, and ultrasound - supported by ACP training and program support.
The Moran Company used data from over 25,000 Medicare A stays across 81 Skilled Nursing Facilities to assess the difference in functional outcomes between those patients that received treatment augmented by ACP program modalities and those that did not. The results of the analysis revealed that in the self-care domain, the use of one or more of the study modalities yielded an improved outcome of 38%. In contrast, treatment delivered without the use of modality yielded an improvement of 27%, demonstrating an 11 percentage point difference between treatment with physical agent modalities vs. treatment without.
In the mobility domain, the use of one or more of the study modalities yielded an improved outcome of 66% compared to a 43% improvement for treatment delivered without a modality, a 23 percentage point difference between treatment with PAMs vs. treatment without.
Interestingly, individuals treated with modalities began at an overall lower level of function in self-care and mobility when compared to those that did not receive modality intervention; yet the end scores for those individuals who received treatment with modalities exceeded those that did not. Additional analysis revealed the average improvement in overall self-care and mobility functional assessment scores were greater for those treated with modalities than for those that were not, across all levels of assistance.
The overall conclusion of the study is that the use of biophysical agents, when clinically indicated, can yield efficient, effective treatment outcomes across levels of independence that are superior to therapy services rendered without biophysical agents. Biophysical agents offer a non-pharmaceutical option to address common underlying impairments, such as pain, edema, tissue injury, and sarcopenia, all of which can negatively impact function. The use of biophysical agents as a compliment to a holistic rehabilitation treatment philosophy that is clinical outcome focused has been proven to optimize gains in function.
The greater rate of improvement achieved when modalities are incorporated as an adjunct to a strong clinical rehab program are certainly important from a patient quality of life perspective, but these results are also operationally impactful if we view them in relation to the new Quality Reporting Program (QRP) Functional Outcome Measures that will go into effect on October 1, 2018. ACP clinical programs and rehabilitative technologies can help skilled nursing facilities achieve greater rates of change in self-care and mobility function and achieve overall higher levels of function at discharge, positioning facilities to benefit from monetary incentives and minimize risk of penalties associated with poor performance on the SNF QRP outcome measures.
Sources/Additional details:
The Moran Company, The Moran Company Report on Therapy Outcomes for Selected Modalities, December 2016
