The PDPM EDGE: Findings from a New Model of Therapy Research Study – Partner Content

As providers prepare for the new reality with the proposed 4.6% PDPM parity reductions in October 2022, they are looking for new strategies to offset these reductions amid the continued cost increases from inflation and lasting effects of the pandemic.

While all vendors can benefit from a laser focus on PDPM accuracy, it is often not enough to offset these new financial challenges. An independent research study conducted by Gravity Healthcare Consulting shows that providers have found cost relief, improved reimbursement and increased treatment margins by switching to a new therapy management model, emerging from EDGE Therapy Solutions. MPPD Refund increased by $14/day from Q2 2021 to Q4 2021 for EDGE providers. And all of this has been achieved while maintaining or improving quality, outcomes and the patient experience.

Most providers have traditionally considered one of two models of therapy: contract therapy and in-house. An exceptional contracted therapy partner provides exceptional support and compliance monitoring, and fully manages all therapy staff. However, contract therapy has become less attractive to some on PDPM because the number of minutes of therapy no longer mandates qualified reimbursement, but the focus on quality and medical complexity has taken precedence.

Internal has become more attractive to some providers with the move to PDPM and reduced emphasis on therapy volume. However, most have found that the true costs associated with ongoing compliance monitoring and effective operational management typically result in negative margins within 6 months of going in-house. And providers are looking for a new solution, which inspired the founders of EDGE Therapy Solutions to create a new model, championing resident, provider and therapist equally.

The research study compared SNF vendor results, costs and final margins for the same months in 2020 versus 2021. All study months were during the public health emergency of COVID- 19, with roughly equal impact of COVID in all 8 communities. . Communities moved from 3 different contracted therapy providers to the new EDGE model, and all communities experienced payroll cost savings of $69,099.07 per month out of the 8 municipalities.

Controlled and efficient growth in reimbursements has also been achieved by all communities. In Q1 with EDGE, communities received $773,870 in Medicare B/Managed Care B reimbursement. This amount increased to $1.03 million in Q2 and $1.29 million in Q3. EDGE increased enterprise provider revenue by an average of 66.7% in three quarters through clinical mentorship, effective systems implementation, long-term care clinical programming, and routine screening.

The Business Intelligence platform used by EDGE includes a wide range of custom reports that enable efficient and targeted monitoring, which can be updated and adjusted to ever-changing regulations and industry standards. “This provides transparency to the process,” said Shaun Smith, vice president of EDGE Therapy Solutions, and allows EDGE experts and SNF ownership to effectively oversee the therapy program.

And overall margins also improved, increasing 11% in April 2021. All therapies costs were reduced by $228,276, and although overall earnings declined, this was actually due to changes in the overall census of qualified people. The communities have set themselves the goal of eliminating the use of agency staff and have chosen to reduce their overall qualified census to maintain quality of care using only in-house associate nurses. Despite this significant change in the availability of qualified residents, EDGE effectively managed therapy services to compensate for these losses, resulting in an overall result increase in SNF supplier processing margins of $93,282 in a single month of April.

Opportunities for New Partnerships: Alternative Staffing Solutions

In an ongoing effort to eliminate on-campus agencies, EDGE communities have seized the opportunity to use therapy associates in new ways, including providing nursing assistant services to cover empty shifts, COVID testing, wellness and active support. In 2021, additional nursing services alone averaged about 1,000 hours provided by associates in therapy per quarter. And because therapeutic resources were not reallocated to the nursing budget, it resulted in a additional savings of approximately $200,000 nursing staffing agency costs for communities in 2021.

Additionally, some communities have partnered with on-site home health agencies to provide therapists. In one community only, this resulted in a additional increase of $48,000 annualized over one year for additional therapy revenue at no cost increase to the SNF provider.

95% retention of EDGE staff

As quality therapists become increasingly difficult to find and more and more therapists leave the skilled nursing sector, the stability of the therapy staff has become a critical foundation for success. EDGE therapists have demonstrated the positive impact of the innovative new model with an average of only 4.62% turnover in 18 months from 2021 to the first half of 2022. Therapists reported increased job satisfaction with the EDGE solution, feeling supported yet independent due to the mentorship and supervision provided by EDGE. Therapists also reported an increased sense of stability by becoming in-house therapists and the elimination of worry about a possible lost therapy provider contract, which typically occurs every 1-3 years for most therapy agreements. under contract.

Additionally, therapists saw increasing opportunities for career advancement with 3 of 8 rehab directors selected for advanced leadership tracks in their individual communities within the first year. EDGE also provides a network for Therapy Managers not possible with traditional in-house programs and allows them to leverage the expertise and successes of their peers to propel their success.

Participation agreement

Uniquely for a therapy management model, EDGE also allows for a participation agreement. This innovative feature allows SNF providers to invest in EDGE in accordance with a determination of fair market value. The resulting profit distributions made by EDGE to SNF providers were not included in this study and would be a potential source of additional revenue for EDGE customers to consider. It allows the SNF provider to participate in the profits obtained by the therapy management company so that when the therapy wins, the provider also wins.

“Compliance is huge”

“Compliance is huge,” said Smith, vice president of EDGE Therapy Solutions. Exceptional compliance monitoring “takes a lot of the worry out of the way,” Smith said. “It’s impossible if you’re not immersed in knowing what you need to know in the industry. EDGE makes it easy for you to get and implement it.

The positives of EDGE

Study results showed that SNF’s treatment margins and provider reimbursement were significantly impacted by EDGE Therapy Solutions’ influence and oversight. Job satisfaction and staff retention have improved with the new EDGE model and clinical mentorship. In these tough financial times, SNF providers need to think outside the box to take advantage of innovative solutions like EDGE. Ashely Haltenhof, Director of Therapy Services at EDGE, sums it up best: “The EDGE management model has been more effective than I ever imagined. This really offers our partners the expertise of a contracted company with the benefits of having therapists as part of their in-house team. Customers are satisfied with financial successes and employee satisfaction. »

Evaluate your treatment options

Key indicators you might need to switch models or vendors may include:

• The therapy does not meet some or most of the residents’ needs – especially long-term care!

• Therapists are not motivated

• Outdated policies and systems = denial and non-compliance

• Productivity is low

• Excessive non-productive time

• Non-compliance in the department

• Therapy does not adhere to appropriate financial budgets

Paul N. Strickland