Getting to the heart of travel healthcare.

A podcast hosted by Sunny & Matt

Podcast Transcript


EP05

Experts Ellen Strunk and Angie Kalasek are the guests on Cardium podcast to talk about the PDPM and the impact on PTs, OTs and therapy.

Patient Driven Payment Model: What It Means for Therapists

October 16, 2019



TRANSCRIPT

Voice Over: Welcome to Cardium, the podcast that gets to the heart of trouble healthcare and asks, "What's your why?" With each episode we explore the topics and issues that impact healthcare professionals in the fields of nursing and Allied Health. Now, here are your hosts, Sunny and Matt from Aureus Medical.

Matt: Hey, Sunny. How are you today?

Sunny: I'm doing great.

Matt: Good. Well, you know jumping into today's topic, it's a different one. It's something that we've not spoke of before but it is on the forefront of a part of our healthcare industry.

Sunny: Yeah, it's very exciting in a way but it's definitely causing waves in the healthcare industry right now.

Matt: Yeah, waves of good and maybe a little bit of unrest, I think.

Sunny: Yeah.

Matt: I think there's a lot of unknown out there and I think that today's podcast will at least shed a little bit more light than I for sure known about it, and PDPM, that's even hard to say, the Patient Driven Payment Model. I don't know how much you know about it but I know how to say PDPM.

Sunny: Yeah, I know how to say PDPM. I don't know much about it. I know that there's a lot of concern, unrest, but also a lot of people that are just wanting to know information. I think we've got two excEllent guests on the show today that's going to be able to provide us a little bit more.

Matt: Yeah, fortunately our audience is not relying upon us to know a lot about PDPM, but we brought in a couple of people that I think will, again, shed some light on it and be able to offer some real good insight. Hopefully, by the time the podcast is out there we'll have a little bit more information.

Matt: With us today, Ellen Strunk. Ellen is an experienced leader in the field of physical therapy and has worked in various roles and settings as a clinician, manager and director. She's the owner of rehab resources and consulting incorporated, which specializes in helping customers understand payment systems in the skilled nursing facility and home health settings, as well as outpatient therapy billing for all provider types.

Matt: Ellen lectures nationally on the topics of regulatory compliance in the post-acute space and other clinical related topics within the rehabilitation therapy world. Ellen is the member of the American Physical Therapy Association, the American Healthcare Association and other professional organizations within her specialty. She's an expert in the Patient Driven Payment Model, PDPM otherwise known as, and we're excited to have Ellen here today.

Matt: Ellen, welcome.

Ellen: Thanks, Matt. I appreciate being here.

Matt: Yeah, thank you for joining us and we're excited to have you here. Also joining us today is Angie Kalasek. Angie brings expertise from the staffing and recruitment perspective of healthcare. She is currently the Division Manager of Rehabilitation Therapy for Aureus Medical Group which places healthcare professionals in hospital, outpatient, skilled nursing and school settings. Angie has been dedicated exclusively to the specialties within therapy her entire 12 tenure. She utilizes her knowledge of PDPM to effectively support therapists and help facilities best meet their workforce requirements.

Matt: Welcome, Angie.

Angie: Hi, great to be here. I'm excited.

Sunny: Yeah, we're glad to have you.

Matt: Yeah, so welcome to both of you. I think that we're going to jump in because this is a big topic and it's a big deal, so let's get started.

Sunny: Well, Ellen, first I'm going to give you a question that I think everyone just needs to know. Give us an overview of what PDPM really is.

Ellen: The Patient Driven Payment Model was developed as a means to move the skilled nursing facility payment system from a system that rewards volume of services to a system that more recognizes patient characteristics. For instance, today a payment for a skilled nursing facility is pretty much determined by how many minutes of therapy are delivered, number one, and if no therapy is delivered then it would be based on what nursing services are delivered.

Ellen: Now, we know because CMS has pointed this out to us many, many times over the last few years that over 90% of all of Medicare days are paid in a rehabilitation rug. Therefore, they believe that the system is incentivizing people to comply a lot of therapy rather than taking patients that may have more physically complex needs.

Ellen: So the system basically looks at various patient characteristics. It looks at functional mobility impairments, self-care impairments, it looks at what is the primary reason for the skilled nursing facility stay, whether or not the patient has a cognitive impairment, whether or not they have a swallowing disorder and then what are their multiple comorbidities or special services that they need?

Ellen: In essence, it is determining the payment rate on all those things and how much therapy is delivered has nothing to do with how a facility gets paid.

Sunny: Okay, and I do have a quick question that just came to mind. Being a former caregiver, in a different realm, I was thinking of back in probably the late 80s, 90s, and you probably know the time frame of utilization review when that came out. Tell the difference between PDPM and utilization review.

Ellen: Well, obviously utilization review can take several forms, but I would say the primary difference is that there is no kind of pre review process. It is basically that once the MDS captures all of the pieces of information and calculates what a payment is and then it is up to the facility to determine what services are needed.

Ellen: For instance, they can decide that if a patient has a swallowing disorder whether or not they need speech therapy and how much they need. There is no requirement that they have to deliver anything. Now of course, that is based on the premise that the provider has the responsibility to provide those services that the patient needs. They will be monitoring some of the quality metrics to insure that the patient outcomes don't suffer.

Sunny: Okay, okay.

Matt: Yeah, that's really interesting, Ellen and I think from, and you eluded to this as you were describing PDPM. I think there's going to be a lot of our audience that really, that want to know from the patient side of things how will this impact patient care? Is this a positive, in your view, is this a positive move for the patients who will be receiving the care in the facilities there?

Ellen: Sure. A lot of it does depend and rely upon the intent of the provider and how well the team collaborates. Patients that have been to a skilled nursing facility in the last year or two, they may recognize a difference, honestly. If they had say a total knee last year and they came in and now they're having a total knee this year and they come in under PDPM, they may see a slightly different look of their physical therapy, their occupational therapy, their speech therapy. Hopefully, they will see more collaboration and less, how should I say this, less emphasis on the number of minutes provided.

Ellen: For instance, today under the RUG system, if a patient isn't feeling well or has some trouble maybe tolerating or participating in an hour of therapy on the first few days of their stay there's an incentive to kind of try to get that patient to participate regardless because you need to meet a certain number of minutes per week in order to get the payment level you think is appropriate.

Ellen: Under this model, that incentive no longer exists and so again, if the patient is doing well or if they need time to adjust to the environment, then there's less pressure to get in there and give them therapy that may not be the best thing for them on that day. Yes, there are concerns that the amount of therapy delivered will be cut back and so that the patients won't get as much, but I think as therapists, we need to really be out there advocating for our profession and I think it is our responsibility to make sure that the patients deliver the right amount rather than letting someone tell us that they don't need as much therapy just because it's October 3, 2019.

Matt: Yeah, that's actually, I mean, when you describe it like that the positive side of the patient care really sounds intriguing. I think that's what most therapists are concerned with is that they want to make sure that their patients are taken care of. I love the face that when you describe the positivity side of things, the patients may in fact have a better delivery of the care that they need instead of trying to go towards the required minutes.

Ellen: Right.

Matt: That's really interesting and I think that that's, you know, again, that's industry wide. We talk a lot on our podcast about the contract travel side of the world and I think, Sunny, it doesn't matter whether you're a permanent healthcare provider or that you are in the travel industry, I think this matters.

Sunny: You know, that leads me to asking Angie, how do you think this will impact the travel industry?

Angie: There's a lot of unknown as Matt said, and we've received a lot of feedback from directors and HR to our current therapists out working and have done a lot of research on our own. Really, it's going to impact that there are going to be a lot less contract needs within those major cities. In general, too. There's going to be less skilled nursing needs. For a therapist in order to remain competitive it is going to be that going outside to some more of those rural areas in order to still have their travel career be robust, and then also, it's just that getting experience in other settings, as well will really help them out substantially.

Angie: We're already seeing some affects that the reduction in our skilled nursing needs. However, there is a clause to that that speech therapy has remained strong. I know Ellen can probably shed some more light as to why that is, but it is going to be, there is a lot of unknown but we do know for sure that there are going to be less skilled nursing needs out there.

Sunny: Ellen, do you foresee, you know, I always think that there's always these changes and I'm going to refer back to how utilization review came and there was like this big oh my gosh, is this going to impact funding? Is this going to impact changes? Are people going to rely more on POS? Things like that when I was a mental health therapist. It was a little bit different. Looking at how this field is, do you see that there is going to be a bounce back and you know, life goes back to normal and needs go up because, obviously, patients still need care. What are your thoughts?

Ellen: Right, right. It remains to be seen. I hope that we will not see a huge change in the therapists position like we saw 20 years ago when the balanced budget act went into place. I was not practicing then, but I have heard that many people in the skilled nursing facilities would write off significantly and there was a huge drop in the number of therapist positions.

Ellen: There has been, as is eluded to, some decrease in the number of therapists, the number of PRN therapists out there. I do think that there will be I like to call it perhaps some right sizing because again, when you are struggling to get a certain number of minutes a week then everything revolves around capturing that within that time period, which means, if a patient was unable to achieve their minutes during the week we got to get weekend staffing in there to do it. If you have admissions on a Friday, you've got to get therapy in there over the weekend to get them started on therapy. Minutes drove that.

Ellen: Now, again, in my rose colored world, patient needs now would drive that. If the primary reason the patient is there is for therapy and therapy is the one skilling them, then they still should be in the facility over the weekend and doing that therapy. Again, it kind of depends on the provider to recognize those needs and do the right thing.

Ellen: That's my first hope is that number one, we don't have a huge drop like we did in years past but that we have more of sort of a right sizing. Now, CMS has said that they are going to continue to look at the data, analyze the data so they will be watching what providers do. I mean, everybody out there should be well aware of that and if they see that lots of therapy minutes are dropping off and providers react in a way that they did not anticipate, then they will do one of two things. One is they will rearrange what they pay and number two, they could go look at certain providers.

Ellen: I'm not totally convinced that there's going to be this sudden decrease in therapists and then in another year we'll see a sudden increase. Hopefully, we'll being to see therapists going to areas that are more difficult to serve. Hopefully we'll see therapists where maybe they've only had PRN staffing because they couldn't hire anybody. Maybe we'll see therapists be able to be hired there so that rather than having these pockets of areas where you have so many therapists and others where you have so few, maybe we'll see some more leveling.

Sunny: Help me understand, too. With this change are we going to see patients, or residents in skilled nursing homes move more towards a group therapy type care? Is that correct?

Ellen: Oh wow. There have been some concerns about that. What Medicare did is that though we've always had a 25% limit on the amount of group therapy that could be provided in skilled nursing facilities, so that will exist today. However, two things, one is that since those minutes count towards your thresholds that you're trying to achieve, then it is harder to get to your threshold when you use group therapy. Without going into all the math, that's not a lot. When you use group therapy it doesn't necessarily help you achieve your threshold any sooner.

Ellen: The other thing that made it hard to deliver is that the definition was so strict. You had to have one therapist to four patients, exactly. They all needed to be doing the exact same thing. In some nursing homes, that's hard to set up finding four people that all can do the same thing. All have similar characteristics and conditions. That's hard to do.

Ellen: In this new PDPM model they modify that definition and they changed it so that it's not one to four people, you can have anywhere from two up to six patients in a group. Which really provides more opportunity for therapists, especially in smaller facilities to use group when it's clinically appropriate. They did that because they wanted to make the definition similar to other settings and so they feel like this will put us on par with inpatient rehab facilities and without patient facilities.

Ellen: I think it will make it easier for therapists to utilize it because now I can do a group with two people. Then plus the fact that you're not struggling to meet a threshold of minutes every week then that might make it easier. From an operator's side, I'm not going to be naïve, of course when you have one therapist providing minutes of treatment to two, three, four, five, six patients then of course, you are going to decrease your labor cost. I do think that we will see more group being used under this model. Again, we as therapists have to insure that it is appropriate and that we're utilizing for the right reasons and not just using it on every single patient just because we can.

Sunny: Thanks, Ellen, for shedding some light on the group therapy. That was one of the questions I wanted to ask you. Especially when looking at the number of patients per group therapy treatment. You know, one question I do have for you, though, is what is the perception out there with that change over more towards that, that group therapy from the therapist view point?

Ellen: You mean the perception of the therapist in what they think of group therapy?

Sunny: Yeah, yeah, mm-hmm (affirmative).

Ellen: Okay, well, you know, I will be honest with you. I have run across many, many, many therapists who have never done group therapy in their career. We have a lot of therapists out there, because you think about this model, this RUG model has been in place for 20 years. You have a whole generation out there who have worked in skilled nursing facilities and they've never used group therapy either because their provider said, you know, we don't want you to use it and they fell in step line with that. Or, because they were never taught how to use it. Maybe they worked in smaller facilities where it just wasn't logistically feasible to get four people in a room at the same time. That is a big problem that people don't know, number one when it might be clinically appropriate, and two, how to organize and schedule something like that.

Ellen: Some therapists are just kind of ignorant to it and so when you tell them you need to start using group now or you can, they say well I don't know how. The other thing, honestly, is that some people look at it as, they kind of have a cynical view that oh, group therapy is only going to be used because they want to decrease labor costs. I have run into some therapists who kind of had that bias about that. I don't think either one is a good place to be in.

Ellen: I think that you should not be so cynical that you think that group therapy is only a way to decrease labor costs because there are some benefits to using group therapy. While we don't have a lot of research to share to support functional outcomes directly to group therapy, there is research that shows that it helps patients become more engaged. That perhaps it can help them understand their impairments a little bit better. It can perhaps motivate them to want to improve by seeing others with the same conditions as them. Certainly, from that standpoint it can help them to perhaps achieve a better outcome.

Ellen: But, it's selection based and making sure that your groups are meaningful, takes time and skill and is something that therapists to learn and you can't just walk into a gym and announce to all of your therapists, hey, I want you to start doing group today without giving them tools to do it the right way.

Angie: Yeah, I bet that it would be a transition especially for reasoning that there's a lot of therapists out there that don't have the knowledge of group therapy and have not been doing it.

Ellen: Right.

Angie: I know that you can't give an exact percent of this, but do you have a rough idea about how much of their day will be doing group treatments?

Ellen: No, I really can't. That's why, I mean, you could imagine that if you just took a whole number and said okay, well CMS has said up to 25% of my physical therapy minutes over this stay could be delivered in group therapy. Group four concurrent, I should say. Theoretically, you could say that one quarter of my time would be. Now, again, I hope that providers are going to be more thoughtful about that and realize that some patients will not be appropriate for group therapy at all. Therefore, it should not be used just because you can. Others it may be that perhaps in the first week or 10 days, group therapy is not appropriate because they're too sick, they're too impaired, that maybe as they are getting stronger and as they are getting more functional, then towards the end of their stay the might be appropriate for more group. You may find that in the first part of your stay you're doing none, and then in the latter part of your stay you're doing more.

Ellen: I hear providers and I hear many saying that they are going to try to build in group. Some are saying yes, that we will try to get up to that 25%. Those are operators, those are businesses talking and looking at numbers and I can appreciate the need to do that. As therapists, we also need to make sure that we are doing the right amount, not just the max amount.

Sunny: I think just from an outsider looking in and not knowing anything, so just, you know, I'm not a clinical professional so let's be clear on this. But, to all of our listeners, when I think of skilled nursing homes and the residents that are there receiving, and the patients receiving group therapy I kind of think just from listening to the conversation that we're having here that there's still a lot of unknown.

Sunny: I'm starting to feel a little bit better because when I think of the group therapy model that we might have to strive for a little bit, I think of these older patients having to have maybe a little bit more help. When I think of a group therapy situation, you know, they will need a little bit more support. I can't think of one therapist and not having maybe an assistant or whatever because they're going to, there's fall risks and things that like that you have to consider. Am I wrong in thinking that?

Ellen: No, no, I don't think you are, at all. Again, it's just a Matter of what kind of personnel are you using to perhaps do that. I know that a lot of businesses out there are looking at how they can collaborate more perhaps with a restorative nursing program, or an activities department. Again, so that they can ensure that patients are staying engaged throughout the say.

Ellen: As I mentioned, one of the big things about the Patient Driven Payment Model is the fact that CMS is really going to be watching functional outcomes. One of the more exciting things that for me as a therapist is that we finally have four functional outcome measures that are being utilized in the skilled nursing facility, the inpatient rehabilitation facility and likely in the home health in future year.

Ellen: What those measures is they measure, CMS said it straight out. We are measuring the value of rehabilitation in these settings. That data has been collected for about almost two years now. Providers are beginning to see some of the results of that. CMS plans to post that publicly. I think that in the midst of this Patient Driven Payment Model and looking at how therapy services might be reimagined and the implementation of more group. We cannot lose sight of the fact that Medicare is watching our functional outcome. If we can do that in a better, smarter way, fantastic. We need to make sure that the tweaks we make to how we're delivering the service doesn't impact those functional outcomes.

Matt: It's just amazing how much that you've already unpacked for us today, Ellen. There's just so much there. I'd love to know how things started. I think a lot of the audience would want to know, is there something that happened a couple of years ago that really started the ground swell of we've got to have the PDPM model in place? Was there an event? Was it something that was on the horizon that everybody saw coming? Can you kind of give us a history or background to that?

Ellen: Yeah, that's a great question. I agree, I've always thought that if you understand a little bit of the why then it's easier to swallow the medicine, right? Yes, you're exactly right. The Deficit Reduction Act of 2005, 14 years ago, actually, was the first legislation that told CMS look, you've created a monster by creating these four different perceptive payment systems in the post-acute care space. You need to really think about how to re-engineer this and come up with one payment model.

Ellen: They embarked on a study and hired contractors and actually did a demonstration. It was called the Post-Acute Care Payment Reform Demonstration. They did that between 2007 and 2011. Of course, it took a couple of years to write the report, but they looked at the report and started circulating 2012-13. Well, Congress got hold of it and were like, "Wow, this is very enlightening. We should really look at reducing costs in post-acute care if we started to cut the systems more aligned, start making incentives be the same thing."

Ellen: They essentially then turned around and passed IMPACT Act. The Improving Medicare Post Acute Care Transformations Act in 2014. That told CMS look, you need to come up with metrics that will be the exact same in [inaudible 00:28:09], skilled nursing facilities, home health and the long term acute care hospitals. If you start having measuring sticks that are the same across all four settings, then we can develop a payment model that will be similar across all four settings. That started in 2014, that's where our functional outcome measures come from and now we have probably, you know, between 10 and 12 measures that are being done the same all across the spectrum.

Ellen: In parallel to this, you have both CMS and you have MedPAC, which is the Medicare Payment Advisory Commission who advises Congress on how much money is left in the trust fund. MedPAC is over there screaming to Congress, look, Medicare is going to go bankrupt. You've got to salvage this post acute care space. Because the spending in this space post hospital has just gone up exponentially over the last 10 years. In an effort to try and get a handle on it, that's why they are developing these models.

Ellen: They have implemented the Patient Driven Payment Model here in Smith for October 1, and then right on the heels of it, January 1 of 2020 home health is going to be undergoing the same massive change called the Patient Driven Grouper Model. Just a teaser there. These two models are looking very much alike. Again, the working hypothesis is that CMS is developing these because this will be the future of what is called a Unified Post Acute Care Payment Model. More change to come.

Matt: Yeah, that's fascinating and I think we're going to have to probably bring you back so you can talk a little bit about that, too. I think our audience will be really intrigued on the home health front. Just to follow up, and you had mentioned this earlier. You know, to make future changes because yes, while the testing has worked out, you know, you roll this out nationally and inevitably there's going to be some adaptation that needs to happen.

Matt: What's your confidence level and what will be done as far as making future changes, modifications to the model itself? Is that something that you're hopeful on? Do you think that that's a realistic expectation?

Ellen: Yeah, I hope they will make it ... Obviously, I think a lot of it will have to do with let's see what we feel six months from now. Are payments to providers, do they seem to be fair? Are there loopholes in the system that we think people are gaining? What are those pieces that are most important to collect, and what are pieces of information that we're currently collecting [inaudible 00:31:03] CMS that really are not informing our decisions?

Ellen: Yeah, I do think that they will continue to make some tweaks. Probably not big changes in the next two years, fundamental changes, but they will be looking at how much money they've allocated to all of these pieces of information and there's actually 188 pieces of information that inform what their payment rate will be. Do I think that they might increase the size of some and decrease the value of others? Absolutely, so that the payment rate continues to be tweaked.

Ellen: As far as huge modifications in the [inaudible 00:31:43], I don't think that they will do that.

Matt: That's interesting, and I think that that just goes to show ... I mean, if you're confident, obviously, Ellen you're very knowledgeable about the topic but it sounds like they are going to need to give it some time before they make any type of modification just because of the size and the breadth of it.

Angie: Ellen, do you see that the home health changes, do you foresee those being pushed back at all or do you see January 1 it will roll out?

Ellen: I see a January 1 roll out, primarily for two reasons. One, it's because they actually finalized the model last year. That was October of 2018 they said as of January 1, 2020 we will be doing this. It has given providers a year or more to prepare. Then, in this years proposal that is out, actually the comments on that roll were due September 7th. They did not pull back at all. They tweaked it a little bit, got some feedback on some minor parts to the model that are mainly to due with claims billing and the request for insurance to pay the payments. No, there is no ... If anybody out there is thinking that they will push [inaudible 00:33:06], they're probably fooling themselves.

Matt: Yeah, you know people are thinking that. You've got to believe that that's the case, but it is good to know, or good to think that you believe that that's going to happen. I think again, Ellen, we're going to have to have you come back because I think that'll be a really intriguing topic, as well.

Sunny: I'm going to change a little direction here. When we're looking at the job market, what would say are the most important takeaways for a health care professional in the field today? How do they position themselves for the job market?

Ellen: Fantastic. I believe that therapists who are, how should I say this? Are working at the top of their game. I think therapists who have simple curiosity, who want to understand the patients health, not just the problem that they came into the facility with, but understand the complexities of their medical conditions, all of them, that they understand our older adult population is very complex. They usually come in with half a dozen medical conditions. They're usually on multiple medications. Does the therapist understand the impact of those medications? Do they understand the impact of this event or this injury on everything else going on in their world? Do they understand how to modify a plan of care based on the social determinance of health?

Ellen: Essentially, what is the patient's cognitive level? What is their educational level? What are they going home to? What kind of care situation do they have? How do you modify your plan of care to address all of those things? If I'm a therapist who comes in and I am kind of taking a [inaudible 00:35:09] approach that everyone of my patients is going to get five times, you know, let's just do a bunch of exercises, let's do some gait training, let's do some transfer training and all my goals look the same and they're not taking into account all of those other variables then the latter therapist I think will be challenged in this world.

Ellen: The therapist who understands that, who is a good communicator and can collaborate with nurses and physicians and occupational and speech therapists, you know, that is the type of therapist that I think will thrive in these models who aren't afraid to kind of be a patient manager, so to speak. That you are thinking beyond just your therapy plan of care under this roof, or in the home, but you're thinking about next steps and you're thinking about how to make sure the patient is empowered, to stay healthy. Those therapists will succeed, I think, and thrive in this new world.

Sunny: As an educator, or someone who is in charge of running these clinical rotation for our student therapists, what would you say they need to be doing and preparing for these PDPM models because it's coming out. They're already in school so there's not a lot of prep time. What do they need to be doing now to get them ready for being out into the field? Those that are already in the field, what should they be doing?

Ellen: I think the the biggest thing that they can be doing is helping them to understand that volume of therapy should not be your primary driver. I know that many times we therapists come out and say, sometimes they may think more therapy is better. More therapy is not always better. Good therapy is better. Helping them to really understand that relationship between dosing of therapy, intensity of therapy, frequency of therapy, helping them understand how to measure their true outcome in things more than just level of assistance. Teaching them how to use standardized tests so that they understand really what is working, what is not working, making sure that they're very strong in their clinical analysis skills. Being able to translate knowledge into practice and then re-evaluating what happened and then again, putting more knowledge into practice, modifying perhaps a few things and then re-evaluating the affects of that.

Ellen: Really being able to do that kind of cycle of analysis on a day-to-day basis.

Angie: That's interesting especially from that student perspective. When thinking about for PTAs and COTAs and how this will also impact them, what's your viewpoint on that?

Ellen: On how it will affect students?

Angie: For PTAs and COTAs.

Ellen: PTAs and COTAs I think will continue to be a valuable part of therapy teams. There are some other threats out there on the horizon to making many assistants feel unsteady or a little bit anxious because of some payment cuts coming to the outpatient world for physical therapy assistant services in 2022. I think that there is a lot of unrest for assistants. As far as their role in post acute care settings, I do believe that they will continue to be a valued part of the team. Again, their skills and their ability to communicate and be able to provide treatments that are evidence based that they think about what kind of therapeutic exercise am I doing. On the OTA side, if a patient has an ADL impairment, is exercise truly the answer to this or is it more of an adaptive equipment and actually teaching and breaking down the ADL task and training it piece-by-piece rather than just throwing a bunch exercises at it like we've done in the last few years.

Ellen: In the last few years it was all about how many minutes you got. That was the focus. Now our focus is coming to outcome. The assistants have to be able to make that shift, as well.

Matt: Yeah, that's fascinating. There is so much movement in the world. I think there's going to be a lot of challenges on the horizon. It can be viewed through a couple of differences lenses. Obviously, the focus of patient care and we love that, but yeah, there's a lot of moving parts to this, Ellen.

Matt: Angie, I kind of wanted to pick your brain a little bit about specifically to the traveling healthcare professional world. If you could, you know, given everything you guys have spoken about today, what are some immediate things to keep in mind from the traveling healthcare professional perspective? Some short term, some things that they would really want to start considering now to adjust to the model, to the change.

Angie: To adjust, one thing that definitely comes to mind is that to ride out some of the bumps that might come about from this is that extend out your current assignment. I think that would be the best thing to do when thinking about career wise. But also, you know, for your resume and then everything that you have that's representing your strengths, fine tune that. Fine tune that because we may see that there is a lot more competition when it comes to submittals for jobs. Some of those individuals that are going to be, in the skilled nursing setting might be flooding other settings.

Angie: Really, beside sharpening your resume is that you can also for interview skills, make sure that you are practicing and then are updated on that.

Matt: Yeah, it sounds like just the open mindedness and just the acceptance of change is probably some of the biggest things that you speak about. I think that the audience, whether people know this or not, there is a lot of demand and not nearly enough supply right now. What you're saying is that you anticipate that there might be additional therapists available for jobs that maybe otherwise weren't available. That's why you would need to kind of sharpen those skills, as you said.

Angie: Yep, yep and then for sure, it will remain a candidate driven market. There is a lot of jobs and not a lot of therapists. That is not going to change, but yes, it won't be as extreme as it is today. That might normalize down the road but for the time being, for the short term, it's something to definitely think about.

Matt: Yeah, fantastic.

Matt: Well, Sunny, I learned a lot.

Sunny: I did, too.

Matt: I hope our audience did, too.

Sunny: We are now at the favorite part of our show where we talk about our why. I'm going to start with Angie. We're going to ask you, and this is my favorite part, I know it's Matt's, too.

Matt: It is, yeah, I love it.

Sunny: This is where we ask the purpose of why you do what you do. Angie, what's your why?

Angie: My why. You know, thinking about really why come in every day and you know, I do what I do. Now, some of you may know this but my brother was in a really bad car accident. A horrible car accident when he was younger. He received tremendous help from his physical therapist, occupational therapist, speech therapist. He would not be where he is today without that.

Angie: Really, my why is that helping bring quality care, getting these patients the true care that they need in order to get back to their normal just as my brother did.

Matt: Yeah, when it impacts you personally like that that's something that's near and dear to your heart. That's why we love to hear these why's because there's so much behind them. There's so much behind them.

Sunny: Yeah, and they're unexpected, too.

Matt: That's great. Thank you, Angie.

Sunny: Thank you. Now, Ellen, the purpose for why you do what you do. What's your why?

Ellen: Oh gosh. Always good to kind of reflect on that, right?

Sunny: Yeah.

Ellen: I had a very special relationship with my grandmother and I always enjoyed being with she and my grandfather and would spend a lot of time with them during the Summer. It was something that I treasured. When I went to physical therapy school, I really thought that I wanted to work with kids. I realized that after my first clinical rotation that that was not where I was cut out to be.

Ellen: I then had my next clinical in a skilled nursing facility and I fell in love. I think it was because of the special relationship that I had with my grandparents, with just appreciating their life stories. I never get tired of listening to life stories. I learned some things. I just think that they are such precious people.

Ellen: I can't really explain how I got to what I'm doing now except to say that I want therapists to feel empowered to help all older adults achieve their best. That best looks different for every single one of them. If I can help people understand payment models so they do the right thing, if I can help them understand a patient’s benefits so that they don't cut off services because they don't think something is going to be covered, then I feel like I have made a difference.

Ellen: I just want to try to in whatever way possible to provide encouragement to therapists working with older adults and to make them realize that it is a very special and a very hard thing. You know, sometimes people think that all therapists do in nursing homes is go in there and just walk people around. We are dealing with very sick people, very complex people. I know I've had the opportunity to change some trajectories out there and it is a very good feeling. That's kind of my why.

Sunny: Thank you so much.

Matt: Well Sunny, again, I learned so much. Ellen and Angie, thank you so much for joining us today. We hope we get you guys back on a future podcast to talk about some more changes. It sounds like we're not done with this bit of a rollercoaster, folks. Hopefully, you'll be able to join us in the future and maybe we can kind of see how the model is working out with PDPM, and then some of the other changes that, Ellen, that you had mentioned that are coming up in the coming months. If that's something you'd both be interested in I think we'd love to have you back.

Sunny: Yeah, that would be great.

Ellen: Sounds great.

Matt: Well thank you both, again. Sunny, again, I learned so much. I think that this…

Sunny: I feel like I was in a college level course right there. I'm like, I hope there's not a test. Please, Ellen, don't quiz me on this.

Matt: Yeah, yeah, I'm glad we recorded this. We can go back and take some notes.

Sunny: Yes, take some cliff notes on this.

Matt: Exactly, it's been fun.

Sunny: That was a lot of great information that was shared and we're going to share that information on Cardium Podcast.com where we'll have show notes as well as other great resources.

Matt: Bye, bye, everybody.

Sunny: Bye.

Voice Over: You've been listening to Cardium from Aureus Medical with your hosts, Sunny and Matt. We're the podcast that gets to the heart of travel healthcare. To subscribe, access show notes or to learn more visit cardiumpodcast.com. C-a-r-d-i-u-m podcast.com. Or, wherever you're listening be sure to rate us, review and subscribe. Thanks for tuning in. Until next time.

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