#28: Payment Models in Post-Acute OT with Clarice Grote (CE Course)

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Full Course Details: Public course page
Learn more about our guest: Clarice Grote, MS, OTR/L

Read the article and discussion upon which this podcast is based.

Course Description

Released March 21, 2022 from Aurora, NE

Spending time in research can deliver the humbling, but needed, reminder that not all therapy leads to clear value for our clients.

For example, in the United States, we can now see that in the 2010s therapy was being delivered in skilled nursing facilities (SNFs)—beyond what was helpful for clients.

Part of the problem was the fee-for-service payment model that incentivized skilled nursing facilities to deliver high quantities of therapy minutes to as many patients as possible. (More therapy equaled more money.)

The research article that we will explore in this one hour course, shows us the humbling data behind this problem. And, it reminds us of why the transition to value-based care continues to happen. The authors specifically look at data around post-acute hip fracture rehab, and compare fee-for-service Medicare versus Medicare Advantage (which is a value-based care program.)

To help us make sense of the changing therapy landscape, we are thrilled to welcome Clarice Grote, MS, OTR/L, is an innovative advocate for occupational therapy and an expert on Medicare post-acute care policy. Clarice will help us understand how this research applies to your individual practice.

Primary Journal Article Explored

When you log in, be sure to check out the OT Potential Club’s written breakdown of the following research article. Then, share your questions and thoughts with fellow practitioners.

Kumar, A., Rahman, M., Trivedi, A. N., Resnik, L., Gozalo, P., &; Mor, V. (2018). Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data . PLOS Medicine, 15(6).

Supporting Research and Journal Articles

Huckfeldt, P. J., Escarce, J. J., Rabideau, B., Karaca-Mandic, P., &; Sood, N. (2017). Less intense postacute care, better outcomes for enrollees in Medicare Advantage than those in fee-for-service. Health Affairs, 36(1), 91–100.

Rahman, M., White, E. M., McGarry, B. E., Santostefano, C., Shewmaker, P., Resnik, L., &; Grabowski, D. C. (2022). Association between the Patient Driven Payment model and therapy utilization and patient outcomes in US skilled nursing facilities . JAMA Health Forum, 3(1).

Learning Objectives

  • You will be able to identify the different financial incentives related to therapy in fee-for-service models versus value-based care.
  • You will be able to describe challenges for occupational therapists in value-based care payment models.

Agenda

Intro (5 minutes)

Breakdown and analysis of journal article (5 minutes)

  • Quick overview of Medicare
  • The difference in incentives for therapy in fee-for-service versus value based care
  • What was the main question driving this research?
  • What were the authors’ methods?
  • What outcomes were they digging for?
  • What were the results?
  • What did the authors discuss?
  • What did the authors conclude?
  • Takeaways for OT Practitioners

Discussion on practical implications for OTs (with guest Clarice Grote) (50 minutes)

  • Can you tell us about how you found OT and what made you become interested in policy?
  • Why is it important to understand payment models?
  • Why is it good for all OTs, even those working outside Medicare and the US, to be following research like this article?
  • Were you surprised by the research findings, like the authors were?
  • What do you think the implications are for OTs?
  • Value based care seems good for our patients, but it shifts therapy from being a revenue driver to a revenue taker. What does this mean for OTs?
  • How do you think OT can prepare for the payment models of the future?
  • Are there any innovative payment models you would like to see OTs embracing?
  • For OTs who are interested in learning more and staying up to date about payment models and legislation, where do you recommend they start?
  • Where would you like to see OT in 5-10 years when it comes to policy and payment models?

Contact Hours

1 hour (0.1 AOTA CEUs)

Target Audience/Educational Level

Our target audience is occupational therapy practitioners who are looking to learn about Payment Models in Post-acute OT. The educational level is introductory.

Instructional Methods/Registration/Special Needs Requests/Cancellation Policy

This course is an independent/self-study course delivered via podcast on iTunes, Spotify and Google Play. Explore your listening options on the OT Potential Podcast page.

If you need accommodations to take this course, please contact us and we will address your needs on an individual basis.

If this course were to be cancelled, please see our cancellation policy on our terms page.

Course Completion Requirements

In order to receive a certificate for this course, you must first listen to the podcast in its entirety. Then, you will need to take the test (found at the top of this page) and earn 75% or higher. If you pass, a certificate will be automatically generated and sent to your email.

Financial and Non-financial Disclosures

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

We here at OT Potential have no financial stake in this topic. Our guest, Clarice Grote, has a financial interest in her own business Amplify OT. She also contracts with the AOTA related to policy issues.

Speakers

Clarice Grote, MS, OTR/L:

Clarice Grote, MS, OTR/L, is an innovative advocate for occupational therapy and an expert on Medicare post-acute care policy. Clarice is the founder and CEO of Amplify OT, a company dedicated to educating and encouraging occupational therapy practitioners and students to engage with Medicare policy and advocacy. She earned her MS in occupational therapy from Columbia University in 2018.

Since graduating she has worked in home health, acute care, outpatient, and lymphedema therapy. Clarice has served as the Advocacy & Policy Coordinator for the American Occupational Therapy Association’s (AOTA) Home and Community Health Special Interest Section and as Director of Practice for the Missouri Occupational Therapy Association. Clarice currently serves as an AOTPAC Ambassador for North Carolina.

Sarah Lyon, OTR/L:

Sarah Lyon, OTR/L headshot

Sarah’s passion is helping fellow OT practitioners translate evidence into daily practice. Sarah earned her BA in religion from St. Olaf College, then earned her master’s degree in occupational therapy from New York University in 2011. Since then, she’s worked in numerous facilities, including a critical access hospital, an acute trauma hospital, and a state inpatient psychiatric hospital.

In 2011, Sarah launched OT Potential because she realized we needed a reliable source of quality occupational therapy-related content and resources. She has also had the opportunity to create content for brands like WebPT, MedBridge, Saebo, and NeuroLutions.

She launched the OT Potential Club in 2019 to marry her love of simplifying complex topics with her desire to help therapists access the most important OT-related research released each year.

Sarah is a prairie girl at heart, which is why she returned to her hometown to raise her children in Aurora, Nebraska (home of the strobe light).

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Please share any other feedback below! Including, ideas for future programming, and most importantly, how you feel this podcast will impact your practice!

Thanks for having me on your podcast Sarah! Can’t wait to see what people think about our conversation.

Great podcast and as an “old” OT, I am glad Clarice is at the forefront and advocating for our profession. She is AMAZING!
A few thoughts: I think a discussion (or at least a mention) of the measurement tool would have been helpful - maybe Sarah gave Medicare too much credit (in my opinion) - just because the sample size was huge does not mean the outcome measured was flawless! Also - is there a case mix adjustment of some sort for patients who have Medicare Advantage? Are they younger? Need less therapy?? Just a thought.
Agree - OTs MUST stay active and ahead of the policy and payment changes - ideally we should be developing them since we are the most holistic lens of the entire system! I am going to look at the CAPABLE model - love the concept of an OT, nurse and handyman is enticing!

2 Likes

Thank you so much Ann! Happy to be doing the work.

The measurement tool was most likely the MDS or Minimum Data Set. It is a Medicare admission/dischrage assessment that is completed on every patient in the SNF regardless of payer type. I believe this study is pre Section GG but don’t quote me on that.

The more recent JAMA article most likley used the MDS and Section GG for outcomes.

The article does state that the MA patients are on averge a few years younger and less cognitvely impaired. I believe they adjusted for this somehow but understand that side of the data analysis is far more in Sarah’s area of expertise than mine :wink:

What’s interesting is the JAMA article that was published a few months ago looking at the same patient population - Medicare patients with hip fractures had similar outcomes and the data sampling was from after PDPM.

As always, data is just data and if it wasn’t recorded accurately on the MDS and Section GG then the results won’t be accurate in the study. So just another reminder of the importance of accurate scoring on all assessments in these settings!

So glad you enjoyed the podcast and thanks for the comment!

1 Like

I love this critique @ann10! And, I actually worried after the podcast if there was some element of analysis that I was missing. I think seeing similar studies with similar results is what gave me a pretty high level of confidence in this research (see our secondary articles above) … but of course the data only tells one part of the story.

Something I would have liked to have seen was PT and OT separated in data extrapolation!

I’m excited to keep revising payment models in the future! And, I agree with you that I really keyed in on the CAPABLE model and hope to do a podcast episode on it in the future. But, in the meantime, here’s the website:

Excellent discussion on the payment models and their impact on therapy service provision! An inspiration to listen to!

2 Likes

That is truly the greatest compliment to hear you took inspiration from this topic :slight_smile: ! @clarice1 is so skilled at looking at past data with clear eyes- and helping us chart a path forward!!

I really enjoyed this pod cast. I work in an environment which does not par with any insurance and found this very informative. I have always found the entire Medicare system confusing, (I am getting to the age for looking into this for myself). I am of the belief that insurances should not be the deciders for what is the proper care or coverage limitation for any individual. I plan to looking the different approaches and models mentioned in this podcast as I feel I need to know more. I am very behind in the times when I comes to patient care changes and navigating the the whole insurance for how to effectively bill for treatments.

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Great information and i am glad to know we as Occupational Therapist in the US have a passionate voice. it’s also a positive to hear about future possibilities within our realm. way to go!

2 Likes

Nice to have subacute focused article. So may work in this area and would be good to have more in the club…

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Hi @kathy! I totally agree with you on this!! If you have any specific topics you would like us to explore, let me know! We are going to be doing some more planning in June!

This was an interesting segment…while I see definite limitations in terms of “value based care” and reimbursement, on a personal and professional level, I do agree there is so much room for improvement in terms of patient insurance and therapy reimbursement. I tend to side with therapists. Ultimately, we’re just trying to do the right thing for our patients and at the same time make a living, and are just players in the game of insurance and reimbursement. That being said, I think documentation is our most powerful weapon-- I think that notion is often met with an eye roll by therapists who are already worked to the max…but in value based models its the only way to get as much therapy a patient and their family/caregivers need before discharge, who in my opinion are often limited in this model.

1 Like