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Hi everyone,
I have been working in the field for a few years now and just want to make sure everyone who is applying or thinking about applying to OT school is aware of the changes that are happening in our field at the moment. This is information schools AKA businesses who need your money to continue running conveniently might not be telling you.
Starting October 1st, SNFs will be implementing PDPM. It's a reimbursement change that Medicare is putting into place due to the years of medicare fraud greedy SNF companies have committed (keeping inappropriate patients on for ultra high minutes). Some changes as a result of this include doing groups vs just one to one treatments so potentially less hours to go around, pay cuts, cutting per diem's d/t RUGs going away, making everything outcome based, flexing therapists to work weekends for evals in order to not use per diem, decrease in reimbursement after keeping a patient on for a certain amount of days (vs keeping a patient on for 100 days), and therapy not driving revenue anymore. Please look up "PDPM" as any article will explain it better than me. My point is due to this change, many facilities across the country are letting go of employees, cutting them down to part time (ridding them of benefits), getting rid of per diem employees (no rug levels to meet so no need for per diems). Per diem used to be a great way to make extra money, to save or pay off loans or have flexibility vs working a full time position--now it won't be as needed in the SNF setting. The changes are similar to when PPS went through and there was more job uncertainty. Some people say it's a cycle that will eventually level itself out--however as of right now these situation is real and happening in our field and some are even looking towards alternative career options due to job uncertainty/staffing changes. At the end of the day--who pays for the greed of these companies? Therapists who have a mortgage to pay, a car to pay off, their student loans and who are trying to sustain a decent standard of living.
January 1st, home health will undergo something called "PDGM" which is a similar model to "PDPM" in that therapy won't be the revenue driver anymore. Home health agencies will get a lump sum and therapy will just be one of the services offered, certification periods for delivering therapy will be reduced, they won't receive financial incentives to deliver more therapy. Right now there is speculation as to how exactly this might turn out but the point is PDGM removes the number of therapy visits as a determinant of Home Health Agency (HHA) payment. Again do your own research into this for a better explanation. Also CMS just proposed a potential 8% cut to reduce reimbursement rates to HH agencies due to suspicions of "shady behavior" like selecting certain reimbursement codes for increased reimbursement etc.
Additionally for those who live in California--the AB5 bill was just passed making it tougher to become an independent contractor. Right now home health agencies are scrambling to find loopholes for therapists to continue working as independent contractors d/t this bill being passed which jeopardizes our freedom to flexibly pick up extra work to supplement our income, or to work home health without the need of having to meet a daily quota (full time).
This isn't meant to be a fear mongering post but moreso an informative one as faculty who work in the schools might be a little out of touch with current changes out in the field and I know some of the draw of becoming a therapist aside from passion or interest is to feel like you have job security especially for all the hard work, years of lost income, and the ginormous and sometimes crippling financial investment that goes into pursuing this degree. Other settings like hospital/outpatient/pediatrics are not undergoing these changes however the reality is (do a quick job search online) much of the jobs are in SNFs and home health.
For those who are already in schools, or for those who have shadowed OT and are hugely passionate about this career--do what you gotta do. You might just need to be more flexible when you graduate or move to a less saturated area to find a job, or wait longer for something to come up.
For those who either didn't get into OT school, on the fence, or still deciding on this career I would perhaps wait out the storm, or do more research on the job availability out there, and what other career options there are that'll provide you a greater return on investment or have a little more job security. Don't base your research off a "TOP 10 BEST CAREERS IN AMERICA!!" fluffy article written by people who have no clue the day in and day out reality of this field.
TALK to actual therapists who have been doing this for awhile. Ask them if they would still do it knowing what they know now. Right now the pendulum of power has swung over to nursing in nursing facilities. They will be making more of the executive decisions in justifying continuation of skilled care. So if you're on the side of "I just wanna help people" vs "I live breathe and eat OT" then consider nursing or even PA (great pay, less physical work, and less financial investment) as well.
For those who have multiple interests such as healthcare AND something like IT-- a growing field that isn't affected by Medicare's moods ...then consider tech. They get raises (ask a therapist in the SNF the last time they received a raise), have great benefits, upward mobility, many work remotely, and a balanced lifestyle and sometimes only need certification to get a job vs. spending hundreds and thousands of dollars on a degree that'll pay avg 60-75k. The other day an IT guy came in to fix our network connection and was saying how he had spent 200 dollars on a certificate that'll advance his career and pay and that the price of this course is now 500--that's a bag of peanuts compared to the amount we spend during our schooling or just a little more than a continuing education course.
I know that as a student all I cared about was making sure to ace my anatomy prerequisite class or making my application as spiffy as possible to get into a school. Do your research and don't enter this field lightly or blindly. There are still opportunities as people need therapy however we have to put up a bigger fight than ever to justify our existence in our volatile healthcare climate.
I have been working in the field for a few years now and just want to make sure everyone who is applying or thinking about applying to OT school is aware of the changes that are happening in our field at the moment. This is information schools AKA businesses who need your money to continue running conveniently might not be telling you.
Starting October 1st, SNFs will be implementing PDPM. It's a reimbursement change that Medicare is putting into place due to the years of medicare fraud greedy SNF companies have committed (keeping inappropriate patients on for ultra high minutes). Some changes as a result of this include doing groups vs just one to one treatments so potentially less hours to go around, pay cuts, cutting per diem's d/t RUGs going away, making everything outcome based, flexing therapists to work weekends for evals in order to not use per diem, decrease in reimbursement after keeping a patient on for a certain amount of days (vs keeping a patient on for 100 days), and therapy not driving revenue anymore. Please look up "PDPM" as any article will explain it better than me. My point is due to this change, many facilities across the country are letting go of employees, cutting them down to part time (ridding them of benefits), getting rid of per diem employees (no rug levels to meet so no need for per diems). Per diem used to be a great way to make extra money, to save or pay off loans or have flexibility vs working a full time position--now it won't be as needed in the SNF setting. The changes are similar to when PPS went through and there was more job uncertainty. Some people say it's a cycle that will eventually level itself out--however as of right now these situation is real and happening in our field and some are even looking towards alternative career options due to job uncertainty/staffing changes. At the end of the day--who pays for the greed of these companies? Therapists who have a mortgage to pay, a car to pay off, their student loans and who are trying to sustain a decent standard of living.
January 1st, home health will undergo something called "PDGM" which is a similar model to "PDPM" in that therapy won't be the revenue driver anymore. Home health agencies will get a lump sum and therapy will just be one of the services offered, certification periods for delivering therapy will be reduced, they won't receive financial incentives to deliver more therapy. Right now there is speculation as to how exactly this might turn out but the point is PDGM removes the number of therapy visits as a determinant of Home Health Agency (HHA) payment. Again do your own research into this for a better explanation. Also CMS just proposed a potential 8% cut to reduce reimbursement rates to HH agencies due to suspicions of "shady behavior" like selecting certain reimbursement codes for increased reimbursement etc.
Additionally for those who live in California--the AB5 bill was just passed making it tougher to become an independent contractor. Right now home health agencies are scrambling to find loopholes for therapists to continue working as independent contractors d/t this bill being passed which jeopardizes our freedom to flexibly pick up extra work to supplement our income, or to work home health without the need of having to meet a daily quota (full time).
This isn't meant to be a fear mongering post but moreso an informative one as faculty who work in the schools might be a little out of touch with current changes out in the field and I know some of the draw of becoming a therapist aside from passion or interest is to feel like you have job security especially for all the hard work, years of lost income, and the ginormous and sometimes crippling financial investment that goes into pursuing this degree. Other settings like hospital/outpatient/pediatrics are not undergoing these changes however the reality is (do a quick job search online) much of the jobs are in SNFs and home health.
For those who are already in schools, or for those who have shadowed OT and are hugely passionate about this career--do what you gotta do. You might just need to be more flexible when you graduate or move to a less saturated area to find a job, or wait longer for something to come up.
For those who either didn't get into OT school, on the fence, or still deciding on this career I would perhaps wait out the storm, or do more research on the job availability out there, and what other career options there are that'll provide you a greater return on investment or have a little more job security. Don't base your research off a "TOP 10 BEST CAREERS IN AMERICA!!" fluffy article written by people who have no clue the day in and day out reality of this field.
TALK to actual therapists who have been doing this for awhile. Ask them if they would still do it knowing what they know now. Right now the pendulum of power has swung over to nursing in nursing facilities. They will be making more of the executive decisions in justifying continuation of skilled care. So if you're on the side of "I just wanna help people" vs "I live breathe and eat OT" then consider nursing or even PA (great pay, less physical work, and less financial investment) as well.
For those who have multiple interests such as healthcare AND something like IT-- a growing field that isn't affected by Medicare's moods ...then consider tech. They get raises (ask a therapist in the SNF the last time they received a raise), have great benefits, upward mobility, many work remotely, and a balanced lifestyle and sometimes only need certification to get a job vs. spending hundreds and thousands of dollars on a degree that'll pay avg 60-75k. The other day an IT guy came in to fix our network connection and was saying how he had spent 200 dollars on a certificate that'll advance his career and pay and that the price of this course is now 500--that's a bag of peanuts compared to the amount we spend during our schooling or just a little more than a continuing education course.
I know that as a student all I cared about was making sure to ace my anatomy prerequisite class or making my application as spiffy as possible to get into a school. Do your research and don't enter this field lightly or blindly. There are still opportunities as people need therapy however we have to put up a bigger fight than ever to justify our existence in our volatile healthcare climate.
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