The 1-2-3 of Therapy: Importance of Communication with the Team

October 09, 2025

The Importance of Communication with the Team

Medicaid is changing the way it pays for care in most states, but that doesn’t preclude us from treating patients and “providing care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being”. (42 CFR §483.24)

We still have a duty to provide therapy services when there is a significant change in a resident’s condition. What is the best way to identify residents who need therapy? Communication! What process does your facility use to notify the therapy team when there is a change? Watch this video from Liz Barlow, Senior Consultant with Blue, to learn more:

Medicaid is changing the way it pays for care

You may have heard that the Centers for Medicare and Medicaid Services (CMS) has required states to transition away from the Optional State Assessment. Most states either already have, or are moving toward, a PDPM-based model for their Medicaid Case Mix systems.

For years, Physical, Occupational, and Speech Therapy have played a key role in many of these payment systems, providing high-quality treatments that help our long-term care residents maintain or restore their function. We’ve all seen the incredible impact these services have on their quality of life.

The Challenge

But here’s the challenge: now that quarterly Medicaid payments aren’t directly driven by therapy minutes, how do we make sure long-term care residents who need therapy are still identified and treated?

The Solution

The answer is clear—communication.
Facilities should have clear processes to notify the therapy team whenever there’s a change in a resident’s condition. I always say that the change could be 1) Something new, 2) Something improved, or a 3) Decline. When notified, therapists can perform a screen—a quick, hands-off review of the chart and a conversation with caregivers to answer one simple question: Is an evaluation needed?

Best Practice – notify someone about the change

Many facilities already use tools like the Stop and Watch Tool from INTERACT. This simple form can be completed by anyone—nursing staff, CNAs, dietary, activities—anyone who notices something different about a resident. From there, the therapy team can take the next step.

Communicate the change

Strong, consistent communication between nursing, CNAs, therapy, and the entire interdisciplinary team ensures no change goes unnoticed.

Because at the end of the day, our residents deserve to reach and maintain their highest possible level of function—and that takes all of us working together.