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The Benefits of Maintenance Therapy Under PDGM

As the home health industry continues to evolve at a rapid rate, successful organizations are those that fully understand regulatory compliance and maximize the benefits of home health to create positive outcomes for their patients.

Among the therapy skills that are not always understood or utilized is maintenance therapy.

Making the Case for Maintenance Therapy

In 2011, the Centers for Medicare and Medicaid Services (CMS) was sued by five individuals and six organizations (Jimmo vs Sebelius). The plaintiffs argued that patients receiving care in home health, outpatient rehab and skilled nursing facilities, who were not able to show improvement, were being discriminated against.

This suit was successfully settled in 2012 and paved the way for skilled services to be delivered, regardless of the potential for measurable improvement. One would hope that this would be a routine, well-understood practice, but that is not always the case.

Who is Qualified to Receive Home Health Maintenance Therapy?

For patients to qualify for maintenance therapy under the home health benefit, they must first meet all regulatory requirements, such as being homebound and requiring skilled need. Where they differ is the expectation for these patients is not measurable improvement, but rather slowing or controlling the decline in function and safety.

Therapists and their organizations need to embrace this paradigm shift from the thought process of, no progress equals discharge, to considering the impact that the discontinuation of services will have on the patient.

Recent clarifications to the Medicare Final Rule also indicate that maintenance therapy visits can be provided by therapist assistance under the supervision of the licensed therapist. As long as clear orders are in place and visit notes adequately capture the skilled need and teaching performed at each visit, there should be no need for concern if these charts are ever audited.

How Often Should Maintenance Therapy be Performed?

Maintenance therapy visits are not generally performed multiple times per week as restorative therapy visits would be, but rather spread further apart. Visits often are centered around a reassessment of the patient’s status with a focus on safety, fall prevention, safety equipment, family and caregiver education and pain management techniques, with the goal of maintaining current functionality.

As patients decline their needs for adaptive equipment and their adaptations to their environment and routines increase, these factors may make occupational therapy the preferred area of focus with some maintenance therapy patients.

A Maintenance Therapy Program Under PDGM

In addition to improved patient care, there are many other ancillary benefits to having a compliant maintenance therapy program. Most late patient-driven groupings model (PDGM) payment periods have a low utilization payment adjustment (LUPA) threshold of only two or three visits over the course of 30 days.

With careful planning, utilizing ongoing therapy services can easily meet this threshold and therefore generate full payment, rather than the LUPA level of reimbursement for that period.

As the home health industry moves closer to pay for performance in the form of value-based purchasing (VBP), patient satisfaction scores, comprising a third of the VBP score, will become a significant direct contributor to organization finances. It is easy to see that patients and families that receive care for a longer period of time, with continued input of skilled therapists in managing their decline, will be likely to rate the organization highly.

Axxess Home Health, a cloud-based home healthcare software, prepares organizations for value-based care with built-in features that prioritize patient satisfaction and maintain compliance, preparing organizations for potential post-payment reviews.


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