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How Will PDPM Affect Traveling Therapists

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The Patient-Driven Payment Model (PDPM) is replacing the current Medicare billing system in skilled nursing facilities (SNFs) on October 1st, 2019. The Prospective Payment System Resources Utilization Groups (PPS RUG IV) has been in place since 1999. Although I was not practicing in the late 90’s, I have heard horror stories from colleagues who lost their jobs in the SNFs during this change in payment system.

Cuts to Medicare first affected my practice in the 2010-2012 cuts, which caused changes to payments for concurrent treatment, group treatment, and assessment period reporting. During this time, as a traveling therapist, I incurred a reduced annual income and reduced job opportunity. The travel job market really dried up. Myself, and many of my friends, went perm for a small amount of time until the market rebounded.

Now, with the changes looming in 2019, clinicians are asking “How will the changes affect travel therapy”. The following blog is my OPINION on the matter, based upon my own personal experiences and educated predictions.

What Is PDPM Anyway?

To make this as simple as possible: the Patient-Driven Payment Model is essentially changing therapy from being a money generator in the SNF to a being a cost. SNF’s will receive an amount of money per patient, based upon different patient classifications. That reimbursement covers all aspects of care, including therapy, during the patient stay.

Payment is not being based upon how much therapy is given. It will not longer make a difference in payment if you see somebody for 719 minutes/week versus 720/minutes a week. While minutes are still going to be recorded, they are not going to be used to determine payment. This is anticipated to lead to a reduction of therapy minutes provided, which will lead to a reduction of staff needed. Therapy will be focused on making outcomes as quickly and efficiently as possible.

To read more about PDPM please check out the Centers for Medicare and Medicaid Services website here:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/therapyresearch.html

I also HIGHLY recommend this MedBridge course. I took this webinar and found it to clearly define the changes to PDPM. You have to be a MedBridge member to access the course. If you are not a current subscriber, I’m a sales affiliate for MedBridge and can offer 40% off your annual subscription with promo code “TravelTherapy”

PDPM: What Does It Mean For Skilled Nursing Facilities

How Will PDPM Affect Travel Therapy

Ultimately, I predict that PDPM is going to affect travel therapy in two main ways over the next couple of years:

Fewer contracts for travelers
Reduced pay

I list these items above with a sense of confidence because this is exactly what has happened anytime that there has been a change to the Medicare billing of therapy. Pay and jobs initially drop. Over time (perhaps a year or so) things tend to even out. As SNF management learns the new system and develops new budgets, jobs tend to increase. However, traditionally an initial hit in the job and pay market has occurred.

From the SNF, there will also be a trickle-down effect. Therapists in SNFs will lose jobs or full-time jobs will go to part-time or PRN. Next, those SNF therapists will leave the SNF market and take jobs in other settings. Then, travel therapists will be less utilized not only in SNFs, but other settings as well. Therefore, it’s not safe to say that if you are a home health therapist, you will not be affected. SNF therapists will be looking for jobs and they will be looking in all areas.

What Can I Do Now To Prepare?

Be Flexible

The more flexible you are in the job search, the more job opportunities. Being open to multiple locations and settings will be helpful for finding a position. Prepare now by getting licensed in larger states with more needs; such as California.

Take A Perm Job In Another Setting

As a traveler, taking a perm job may seem like the end of the world. However, think of this as a learning opportunity and a chance to expand your professional skills. Take a perm job in a setting that you want to learn and that could improve your resume when you get back to travel. E.g. home health, pediatrics, or an outpatient specialty. Use this time when the job market may be slow to expand yourself and your resume.

Transition Into Pediatrics

There will likely be a lot of therapists who leave SNFs and leave adult practice altogether. Some may transition into pediatrics. Get ahead of the curve by transitioning into pediatrics now. There is a growing need for SLP school therapists and other pediatric disciplines.

Diversify And Grow Your Resume Now

There will still be a need for traveling therapists when the PDPM changes occur, although maybe not as large as the need is now. Therefore, you may be in competition with multiple other therapists to get a position. Set yourself and your resume apart now by having a skill set that a manager cannot say no to. Whether its diversifying across multiple settings (home health, outpatient, etc), or taking CEUs to become specialized in a certain area, make yourself a valuable job candidate.

Remember: under the new payment system, minutes don’t matter. Being a highly qualified clinician who can help patients achieve goals faster is going to positively impact payments. Be a clinician who adds value to your team and your patients.

Save Money

Being a traveling therapist for 8 years, I have seen money go up and down in this market. When the job market is saturated, jobs pay less. When you have 20 highly-trained applicants for a single position, you don’t need to pay as well as when you cannot get a single qualified applicant. It’s supply and demand.

That being said, jobs are paying relatively well now. Strike while the iron is hot and save money now to prepare for any future loss. Pay off debt, have an emergency savings, and plan ahead financially in case you have to go a prolonged amount of time without a contract.

Conclusions

PDPM, a new Medicare reimbursement system, is beginning in SNFs on October 1st, 2019. This change is predicted to impact the job market and wages for traveling therapists, initially and perhaps over time. While you have time to prepare for these shifts now, consider growing your personal resume or taking a permanent position. Historically, travel jobs have been temporarily impacted by changes to Medicare reimbursements, and have not taken a substantial long-term decline.

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20 thoughts on “How Will PDPM Affect Traveling Therapists”

    1. Unfortunately, COTA demand has been decreasing for a while. More than anything, I think it has to do with supply and demand. There are a TON of new COTA schools and an influx of new COTA’s in the market. Many people who would normally take a perm job are considering travel because they cannot find a job at home. It’s one of the harder specialities to find a contract in now.

      1. What are your thoughts on this new system and how holidays will be handled? I see not only travel but also PRN therapist being used less often.

        1. You mean who will staff holidays? I guess that depends on your SNF. Already, a lot of SNF’s are making their full-time staff cover holidays.

  1. Hi Julia!

    I’m an SLP with 2 years of working in a SNF. As an SLP, do you see a decrease in need in traveling SLPs? I’m under the impression that this change will not affect our profession as much as PT and OT seeing how we do not have assistants. Plus, many of our patients may not be appropriate for group sessions due to cognitive-linguistic deficits. What are your thoughts on how this will affect SLPs specifically? I greatly appreciate your insight and leadership.

    1. Hi thanks for the message! I think that the need for travel SLP’s may drop a little in the SNF market. Schools still look good. It’s really hard to say at this time. I think a lot of SNFs may hold off on staffing travelers until they have a better sense of what the changes are to income and running the department.

  2. I’m a OTA in the South and it’s so difficult to find OTA help for me. There is only 1 school in the state for this profession and my facility can’t find an OTR to hardly help either when my PRN OT is out. I also do home health on the side and they too are in need of help. Should I stay in the snf or switch to home health? Just don’t know what to do with my career. I’ve been an OTA for 20 years and getting burned out with snf but with all the upcoming changes I don’t won’t to leave and regret it. I thought about doing half snf and half home health. What direction should I take? Just need some sort of security.

    1. It sounds like you have a lot of job security in your area and opportunities. Do what you feel is right at this point in your career. If you get trained in HH and even work PRN there, it’s another valuable skill to add to your resume.

  3. Hi, I’m wondering how the utilization of PT’s vs. PTA’s will be with PDPM in SNF settings. Are SNF’s going to be paid the same whether or not it’s a PT vs a PTA? Will there be greater utilization of PTA’s since they cost less. Thank you! Pat

    1. I read that PTA and OTA reimbursement rates via CMS will decrease by 15% starting in 2021/2022. This may cause an issue with employment and/or a decrease in pay rate. We’ve been battling with the issue of CMS separating us for many years now, it just continues… but I don’t think our profession will ever go away.

  4. Layoffs happening all over MA in prep for oct 2019. Therapists with 20+ years experience being replaced with new grads at part time. There are no FT positions anywhere. I got my pink slip 2 weeks ago. Interviewing in another field but I’m 50 so now I’m encountering age discrimination. I regret ever going into field.

  5. I am a OTA with 20 years experience. I saw the PPS changes in 1999. It was a difficult time, so difficult that I went back to school and got my RN in 2005. I kept my license with a little experience here and there on the side but worked full time as an OTA. I recently made the transition back to nursing (due to the PDPM scare) and am now in Clinical Quality Improvement for NCQA measures at a HMO. I am making more money and love it! The OTA field is completely flooded and my last job hadn’t given raises in 12 years. I wen’t back to school and just got my BSN, starting APRN school next year. There is always an alternative guys! You can go back to school, or get creative and use your skills in different areas. Especially for those of us with a lot of geriatric experience…that is a valued skill nowadays. I had plan B many years ago and so glad I did, but there are other things you can do with your current degree.

    1. Thanks for the inspirational story! It is so true that we are capable of so much. Don’t limit yourself to one small area of work.

  6. I am a COTA in the South working full time in Pediatrics. I used to make ends meet with my PRN jobs. Now, since Oct 1st, I haven’t had a single call at my usual SNFs. ” No work”, “Going crazy”, “may be in the future but not for now”. Those are the answers I got when I call to inquire about possible weekend hours. I am worried. Any suggestions?

    1. Hi sorry to hear that. Unfortunately, I really don’t have any suggestions for getting PRN work in the SNFs at this time. Everybody is really cutting back on staff and in panic mode at the moment. If possible, maybe look into pediatric positions or acute care. Best of luck!

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