Value-based. Quality-driven. Pay-for-performance. These are some of the buzzwords you’ve probably heard being bandied about in the healthcare payment world. And all that buzz is only going to get louder with time, because no matter how you choose to describe it, the movement toward better care at a lower cost is picking up major steam.

As we already covered in a previous blog post, that movement has manifested in the formation of several different alternative payment models, including shared savings, bundled payment, and capitation. But the push for payment reform doesn’t stop there. Another major development in the hopper: a complete overhaul of the mechanism through which healthcare providers actually record and submit their charges. At this point, there’s really no question that the CPT coding system is going to need a major makeover to accommodate the transition to a pay-for-quality environment.

That’s where the APTA’s proposed alternative payment system comes into play. This proposal—which has been several years in the making—falls somewhere in the middle of the value-based payment spectrum. That is, it accounts for the specific services providers perform during treatment, but—in an important departure from the incumbent system—it also accounts for the complexity and severity associated with the provision of those services and the patients receiving them.

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Here’s a short breakdown of the proposal’s features:

  • 2 overarching categories of CPT codes: evaluation and intervention
  • 12 possible codes for evaluations:
    • 4 for physical therapists
    • 4 for occupational therapists
    • 4 for athletic trainers
      • Range of evaluation coding options reflects the range of exam complexity
  • 5 collapsing levels of interventions:
    • Accounts for the severity of the patient’s condition and the intensity of the associated clinical decision-making, treatment provision, and risk
    • Payment for a single intervention is not the same in every case

The APTA has already conducted pilot testing for this system, and based on the results of that exercise, the organization identified a handful of issues it must address before rolling it out on a grander scale. However, according to the update APTA representatives provided during CSM 2015, PTs could see a partial implementation of the system as early as January 2017.


Does your practice have a plan for taking on the shift to pay-for-performance? What do you think of the APTA’s proposal? Share your thoughts in the comment section below.

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