On January 1, 2020, home health agencies (HHAs) will implement the patient-driven grouping model (PDGM) for Medicare reimbursement, which bases payment for patients with speech-language pathology needs on their clinical characteristics. Here are some ways in which speech-language pathologists (SLPs) can demonstrate their value in this new payment model.
SLPs play a critical role in identifying patients for treatment and determining their plan of care. Comprehensive coding that recognizes all diagnoses and comorbidities/complexities is critical.
Therapists play a critical part in ensuring quality improvement and avoiding payment adjustments under the value-based purchasing program (VBP), the quality reporting program (QRP), and Home Health Compare.
Engaging SLPs in the completion of relevant sections of the OASIS ensures accuracy of the data, helps identify patients who need speech-language pathology services, and facilitates interprofessional practice. SLPs can contribute to this process either directly or in consultation with the HHA staff who complete the OASIS. For example, the patient’s level of functional impairment is one factor for payment. SLPs can help identify patients at risk for hospitalization as a part of this functional assessment.
OASIS Question | Descriptor |
---|---|
M1800 |
Grooming |
M1810 |
Current ability to dress upper body safely |
M1820 |
Current ability to dress lower body safely |
M1830 |
Bathing |
M1850 |
Toilet transfers |
M1850 |
Transferring |
M1860 |
Ambulation/locomotion |
M1032 |
Risk of hospitalization |
All disciplines must step outside their silos and collaborate more to ensure that patients receive adequate care. Agencies must remember that SLPs can improve/enhance goal achievement in other disciplines through improvement of a patient’s communication and cognitive deficits.
Although the medication management clinical category does not include a therapy payment, SLPs effectively develop strategies and tools to ensure that patients can manage their medications safely and accurately. This is particularly important for patients who are not compliant with their medication regimen due to a swallowing disorder.
Medicare requires HHAs to have a plan in place to mitigate decline of patients due to pain, falls, skin integrity, and depression. The SLP can be useful in implementing strategies to assist with pain management (e.g., ability to adequately communicate pain, request pain medications) and fall prevention (e.g., using compensatory strategies and valid tools such as The Spaced Retrieval technique).
Questions? Contact ASHA’s health care policy team at reimbursement@asha.org.