Therapists have been squirming plenty ever since the Patient-Driven Payment Model came out. Now comes research that adds a few more porcupine quills to the discomfort.
squirming plenty ever since the Patient-Driven Payment Model came out. Now comes research that adds a few more porcupine quills to the discomfort.
Scientists have released results questioning the use of productivity goals. The implications, to put it politely, are not good.
The major finding is that physical therapists whose employers emphasized productivity goals over evidence-based practice were six times more likely to report “high frequency of observed unethical behavior.”
Overall, 89% of the 3,400-plus respondents said they observed unethical behavior of some kind. On the plus side, most (69%) reported it happening “rarely” or “never.”
Skilled nursing respondents were the biggest sub-group (754) of respondents — and were worst in every category. Clinicians in SNF settings were four times more likely to report high frequencies of unethical behavior than all other settings, said lead researcher Justin E. Tammany, PT, DPT, SCD, MBA, an assistant professor of therapy at the Holland School of Mathematics and Sciences at Hardin-Simmons University.
Tammany said he hopes that shining a light on the results will help eradicate questionable practices.
“It’s kind of the dirty little secret that everybody knows is going on,” he told me. “But clinicians are feeling powerless to do anything about it. Maybe it will help with some data on it.”
Three-fourths (74%) of all respondents had a formal goal set by an employer. That meant measurements by units-per-billable hour for 85% of them. Moreover, 83% said that productivity goals influenced their clinical decision-making.
Tammany said he wanted to get findings out in the open before the Patient-Driven Payment Model goes into effect October 1. PDPM, of course, eliminates therapy being paid by the minute, something Tammany said has compelled a lot of bad behavior.
Heads must be nodding about the study throughout the halls of the Centers for Medicare & Medicaid Services.
“Part of the issue is anytime reimbursement changes, we come up with a new rate and fudge data or do a workaround to increase reimbursement,” Tammany explained. “It would be a great thing when that’s not an issue any more and there’s more of a push for quality-based reimbursement.”
From the April 1, 2019 Issue of McKnight's Long-Term Care News
