ArticleJournal of the American Medical Directors Association2021
Therapy Staffing in Skilled Nursing Facilities Declined after Implementation of the Patient-Driven Payment Model.
Article in Journal of the American Medical Directors Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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The trial behind it
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Who cites it
15 citing papers in PubMed, 25 citations in OpenAlex.
- Consistency of post-acute care discharge recommendations among acute care physical therapists: a national vignette survey study.Physiotherapy theory and practice · 2026Article
- Patient Functional Outcomes in Skilled Nursing Facilities: The Mediating Role of Declining Therapy.Archives of physical medicine and rehabilitation · 2026Article
- Reductions in Therapy Provision in Skilled Nursing Facilities After Medicare Payment Reform and During the COVID-19 Pandemic: An Interrupted Time Series Analysis.Archives of physical medicine and rehabilitation · 2025Article
- Changes in skilled nursing and home health admissions associated with Medicare payment reforms and the COVID-19 pandemic.Journal of the American Geriatrics Society · 2025Article
- Analysis of the integration of medical and nursing care and its association with depression and anxiety among medical staff in the Jinhua area.Frontiers in psychiatry · 2025Article
- Association of Rate of Functional Recovery With Therapy Time and Content Among Adults With Acquired Brain Injuries in Inpatient Rehabilitation.Archives of rehabilitation research and clinical translation · 2024Article
- Is More Always Better? Financially Motivated Therapy and Patient Outcomes in Skilled Nursing Facilities.Archives of physical medicine and rehabilitation · 2024Article
- The Global Status of Occupational Therapy Workforce Research Worldwide: A Scoping Review.The American journal of occupational therapy : official publication of the American Occupational Therapy Association · 2023Article
- Severe neighborhood deprivation and nursing home staffing in the United States.Journal of the American Geriatrics Society · 2023Article
- Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities.Journal of the American Geriatrics Society · 2023Article
- The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs.Healthcare (Basel, Switzerland) · 2023Review
- Limitations and Recommendations for Advancing the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis of the Literature.International journal of environmental research and public health · 2022Article
- Type of Findings Generated by the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis.International journal of environmental research and public health · 2022Article
- Medicare payment policy in skilled nursing facilities: Lessons from a history of mixed success.Journal of the American Geriatrics Society · 2021Article
- COVID-19 Pandemic Impact on Nursing Homes Financial Performance.Inquiry : a journal of medical care organization, provision and financingArticle
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThe Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing.
designSegmented regression interrupted time series. SETTING AND
participants15,432 SNFs in the United States.
methodsUsing SNF Payroll Based Journal data from January 1, 2019, through March 31, 2020, we calculated national weekly averages of therapy staffing minutes per patient-day for all therapy staff and for subgroups of physical and occupational therapists, therapy assistants, contract staff, and in-house employees. We used interrupted time series regression to estimate immediate and gradual effects of PDPM implementation.
resultsTotal therapy staffing minutes per patient-day declined by 5.5% in the week immediately following PDPM implementation (P < .001), and the trend experienced an additional decline of 0.2% per week for the first 6 months after PDPM compared with the negative pre-PDPM baseline trend (P < .001), for a 14.7% total decline by the end of March 2020. Physical and occupational therapy disciplines experienced similar immediate and gradual declines in staffing. Assistant and contract staffing reductions were larger than for therapist and in-house employees, respectively. All subgroups except for assistants and contract staff experienced significantly steeper declines in staffing trends compared with pre-PDPM trends. CONCLUSIONS AND IMPLICATIONS: SNFs appeared to have responded to PDPM with both immediate and gradual reductions in therapy staffing, with an average decline of 80 therapy staffing minutes over the average patient stay. Assistant and contract staff experienced the largest immediate declines. Therapy staffing and quality outcomes require ongoing monitoring to ensure staffing reductions do not have negative implications for patients.
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