This is ASHA Voices. I’m J.D. Gray … with something a little unusual.
This isn’t a full episode, but we have an important update to a story that we’ve been following.
A few weeks ago, we brought together a panel to look toward, and speculate on, the implementation of the Patient Driven Payment Model, a new system that is changing the way Skilled Nursing Facilities are reimbursed for services under Medicare.
While the previous model reimbursed for minutes of service delivered, PDPM reimburses for services based on patient characteristics. This is meant to discourage facilities from providing more therapy than medically necessary.
Then…almost immediately after PDPM went into effect on October 1, we started to hear from members saying their jobs were changing drastically. We received emails and phone calls from SLPs who were let go. Or who found their hours and compensation reduced. And we heard of a decrease in time people were spending with patients.
These stories vary between Skilled Nursing Facilities. Some have pointed to an increase in group and concurrent treatment as one factor in these cuts.
We asked SLPs to leave us voicemail messages with their stories. Others connected with us by phone. Just a note, some of these members requested that we exclude their name, and we’re respecting that. We think these messages are an important part of the conversation surrounding PDPM, and as a way to follow the story, here are those voices now:
I am a part time speech therapist with a company in VA. I would say about 3 weeks prior to October 1 the company sent out emails to our PRN staff. It was just saying that due to the upcoming changes for PDPM that they were going to be cutting everyone’s pay by 3%. Then a couple days later I received a call from my regional manager giving me the same spiel about changes coming up and because of that, they were actually going to be cutting my pay as well. However, when she told me how much it was going to be, it was significantly more than 3%.
I work in Dennison, TX a skilled nursing facility. You know, since PDPM came in, I have been getting 15 minute treatments with a big emphasis on groups. So, for example, yesterday, I had 8 patients for 15 minute treatments. Anyways, I’m concerned. I’m concerned about how I can handle this ethically.
The reason I’m calling today is because I’ve been negatively affected by PDPM changes in the skilled nursing environment. Prior to October 1, I was treating Medicare part A patients 5 times a week for 30 minutes and could generally ask my rehab manager for more minutes if it was clinically warranted without problem. Since PDPM, I am now only seeing my Medicare A patients three times a week, and I’m told it’s because they’re scheduled for group therapy with PT and OT two times a week. On the days they received group therapy, they’re no longer going to receive speech therapy due to the number of minutes that would be having them participate in therapeutic services.
So, I was at home, and I had received a phonecall that I was supposed to call our regional manager, so I go ahead and I give him a call back at 8:30 pm, and he basically said that he wanted to review some of the changes that PDPM were going to happen and how it was going to affect our building and effect my position as a full-time speech pathologist. And then he went on to say that due to lesser needs I guess of the therapy manager role, that that person would be taking two hours from me each day. No matter what my case load was. So if I had about 2.5 hrs of patient care on a given day, 2 of those hours were going to go to her.
I did lost my benefits, yes, as of October 1. So thankfully, I got married, and I can get on my husband’s benefits but no paid time off or anything like that
The nice thing I’ve noticed is, there’s nobody saying you have to get 45 minutes today. So if I’ve been with a patient and I thought we could end a little bit early because we finished one task and there was only going to be about 4 more minutes to start another task, why not just finish up one and begin the next task the next day?
Some of the pressure has been alleviated I guess, and I’m not sure that it’s any better. Because it’s one thing to over serve a patient, but it’s the under serving that’s hard.
Ok. I’m a speech therapist in Texas. September 30, that afternoon we got a phonecall from the regional in the corporate office that pretty much half of our team got left go, effective immediately, and that come October 1 everything was going to change, but not to worry.
The second day kind of went as usual, kind of implementing the changes, and when we all came to work October 2, I had noticed that most of my treatment time had been cut in half. When I questioned what was going on, it was well… PDPM has now had analytical run in to say this patient for this diagnosis should only need 15 minutes of therapy a day. I tried to say, well this same patient was on 30 minutes yesterday, and I don’t see how I can provide the same treatment in half the time, and I was pretty much told that was the new expectation and that if I can’t stay within those guidelines then I would be let go.
I had a lot of ethical issues right off the bat with that.
But also, I’m stressed. My blood pressure is high. I’m having anxiety attacks, and my regional doesn’t care. It’s pretty much been told to me. If you can’t meet these standards, you can join the rest of them and be let go. And when I asked her about that, of course, she denied all of those claims.
So at the end of the day, we have to go home and put food on the table for our families, but at the same time question, are we doing this ethically. I used to go home being safe and put my head on my pillow, and now I’m like, ‘did I do the right thing? Am I gonna lose my job? So I have to outweigh in the balance: do I continue being a speech therapist if this is going to be what it’s like, or do I just hang it up and be a stay at home mom?
Those were just a few of the voices of SLPs who were affected by PDPM.
In the days since we started hearing from members, ASHA released a statement to say that we are disappointed and deeply saddened by the reports of SLPs losing their jobs or contracts. And just last week, ASHA staff met with representatives from the U.S. Department of Health and Human Services to talk about PDPM’s implementation and evaluation. We’ll continue following this story as it develops on this podcast, in the pages of the ASHA Leader magazine, and on the Leader Live blog.
You can find more stories from SLPs working in SNFs on the Leader Live blog and find resources and information about PDPM by going to ASHA-dot-org and searching for PDPM.
That’s it for this week. Just a quick episode to update you on PDPM and skilled nursing facilities.
We’ll be back next week with a regular, full-length episode featuring voices from the upcoming ASHA Convention. You won’t want to miss that one. Until then, I’m J.D. Gray, and this is ASHA Voices.