On the WebPT Blog, we’ve extensively covered the benefits of tracking and accurately analyzing outcomes data—from why it’s essential for patient safety to why it’s necessary to brand physical therapists as neuromuscular experts. But, as we move toward a pay-for-performance healthcare paradigm, objective outcomes data won’t merely be beneficial to physical therapists; it will be necessary for them to get paid. Here’s why:
Payers Depend on Data
Payers are transitioning to reimbursement structures rooted in service value—rather than service volume. And to prove the value you provide, you need a way to communicate the efficacy of your care to payers. So, how will you do that? You guessed it: through tracking and analyzing outcomes data. If you’re a Medicare provider, data-tracking should already be part of your routine. After all, you’re already submitting data through a number of channels—including the PQRS and FLR programs. That said, there is a difference between outcomes data and the other data you’ve previously collected: outcomes data—particularly data collected via patient-reported outcome measures—emphasizes care quality and patient satisfaction, two important factors in care value.
New Initiatives are Paving the Way for Healthcare Payments
One of the ways that the government is moving the entire US healthcare system toward a value-based mode of care delivery is through the introduction of the new Merit-based Incentive Payment System (MIPS). What is MIPS? Essentially, this new initiative consolidates three existing pay-for-performance programs and introduces one new program—all in an effort to more strongly encourage providers to deliver higher quality care at a lower cost. The whole shebang is set to go into effect in 2017. If you’re interested in learning more about the ins and outs of MIPS, check out this post.
So, how does MIPS impact rehab therapists? Unfortunately, as of right now, therapists aren’t eligible to participate. As Brooke Andrus explains in this article, a limited list of clinicians will be eligible to participate during the first two years of the program. These providers include:
- physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs),
- certified registered nurse anesthetists, and
- groups that include the above-listed professionals.
Now, while rehab therapists won’t be able to take part in MIPS right off the bat, PTs, OTs, and SLPs will become MIPS-eligible beginning in 2019. At that point, therapists may be required to report a variety of data points. To properly prepare for that day, therapy providers should get used to tracking quality data now—before their payments depend on it.
Alternative Payment Models
In addition to introducing programs like MIPS, the Centers for Medicare and Medicaid Services (CMS) is rolling out a host of programs to encourage provider participation in alternative payment models—and thus, move closer to the US Department of Health and Human Services’ (HHS) goal of tying 50% of all Medicare fee-for-service payments to alternative payment models by 2018. One example that’s already in place is the Comprehensive Care for Joint Replacement Model (CJR). CMS explains that the “CJR model holds participant hospitals financially accountable for the quality and cost of a CJR episode of care and incentivizes increased coordination of care among hospitals, physicians, and post-acute care providers.” This model holds providers accountable for care quality and cost—rather than reimbursing based on service volume alone.
Collaborative Care is the New Normal
In the next few years, the importance of proving the value of your services will only continue to grow. In the words of this Medical Economics article, “the shift from fee-for-service (FFS) to value-based reimbursement will be even more dramatic [in the next two to five years].” And that means providers must prepare now—or risk being left behind. Bottom line: the rehab therapy community has no time to waste. Furthermore, as this Modern Healthcare article explains, the healthcare powers that be clearly believe this transition is mission-critical—despite the massive investment of time, money, and labor that comes with it: “while the movement away from fee-for-service and toward value-based care requires a hefty investment in infrastructure, cultural changes around operational practices and intensive care-redesign efforts, these developments clearly illustrate that providers are being pushed to change and embrace a new normal.”
And that new normal includes a move to a more collaborative, patient-centered care delivery paradigm. In fact, that’s arguably the overarching goal of healthcare reform in general—and it’s one more reason outcomes tracking is crucial to rehab therapists’ ability to survive and thrive in the future. As the APTA explains, “the ability to measurably demonstrate objective results is critical in the pursuit and development of collaborative health care relationships. This will require you to be up-to-date on clinical practice guidelines and protocols as well as to be able to document your adherence to evidence-based practices sufficiently, and share your data with bundle partners.”
Are you tracking outcomes data? If not, what’s stopping you from embracing this new normal? Let us know in the comments section below.