A recent story highlighted the dramatic rise in ultra-high therapy use in SNFs, but are there legitimate reasons for it?
Two days ago, The Wall Street Journal had a front page story about the sudden increase in the percentage of patient days in skilled nursing facilities using “ultra-high” therapy, which is a maximum of 720 minutes per week. Apparently, in 2002, nursing facilities gave ultra-high therapy to patients on 7% of the days they billed to Medicare, but this increased to 54% of patient days by 2013, with the percentage increasing every year. The gist of the story was that providers have been gaming the system to get the highest reimbursement. I had hoped we were getting beyond that in our industry. But one thing the story missed is how the skilled nursing industry has been trying to treat higher acuity patients. Almost by definition, these patients would require more therapy minutes than the Medicare patient of old, or 10 years ago, so some increase in ultra-high therapy use would be expected. But 54% of all patient days billed to Medicare? Seems like a stretch to me, and I just hope it does not result in any new restrictions in the direction SNFs are going with higher acuity. That would be a mistake.
