{"id":562,"date":"2015-12-08T09:00:58","date_gmt":"2015-12-08T09:00:58","guid":{"rendered":"http:\/\/fitpt.fitbux.com\/?p=562"},"modified":"2020-06-15T20:24:43","modified_gmt":"2020-06-15T20:24:43","slug":"the-move-to-pay-for-quality","status":"publish","type":"post","link":"https:\/\/www.fitbux.com\/fitpt\/interviews\/the-move-to-pay-for-quality\/","title":{"rendered":"The Move to Pay-For-Quality"},"content":{"rendered":"

The following article was published by Brooke Andrus on WebPT.\u00a0 The original can be viewed by clicking here.<\/a><\/p>\n

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Your mission, should you choose to accept it, is to provide higher-quality care at a lower cost. With the healthcare industry\u2019s fast-moving transition to value-based\u2014rather than service-based\u2014payment systems, that\u2019s the challenge many providers are facing. And while that mission may very well seem impossible, the truth is that rehab therapists and their peers in other medical fields don\u2019t really have much of a choice as to whether they\u2019ll accept it.<\/p>\n

The winds of change are already blowing\u2014some might even say howling\u2014and the only way to make sure you don\u2019t end up lost at sea is to take control of the sails and point your boat in the direction you want to go. But, whether you\u2019re a top-secret government spy, a storied ship captain, or a PT private practice owner, the first step to overcoming any challenge is gaining a thorough understanding of what, exactly, you\u2019re up against. With that in mind, here\u2019s a breakdown of healthcare payment models and how they fit into the developing better-care-lower-cost picture.<\/p>\n

The Current Model: Pay-for-Quantity<\/h3>\n

As it stands, the amount of payment a therapist receives for each treatment session is determined by:<\/p>\n

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  1. The CPT codes the therapist bills, and<\/li>\n
  2. The number of units associated with each CPT code.<\/li>\n<\/ol>\n

    Now, that\u2019s a very bare-bones analysis of how things work in the fee-for-service world therapists have lived in for decades. As Larry Benz explains in this Evidence in Motion (EIM) article<\/a>, the monetary value of each code also depends on the Resource-Based Relative Value Scale (RBRVS)\u2014which accounts for a practitioner\u2019s geographic region\u2014as well as a fixed conversion factor that updates annually. So, this system financially rewards providers who:<\/p>\n

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    1. Perform the most expensive modalities (i.e., the services whose associated CPT codes are worth the largest dollar amount), and<\/li>\n
    2. Bill for the largest possible quantity of units.<\/li>\n<\/ol>\n

      What\u2019s wrong with this picture? Well, it provides absolutely zero incentive for practitioners to factor efficiency into their plans for care delivery. In other words, therapists have no financial reason to either:<\/p>\n

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      1. Provide\u2014and bill for\u2014fewer services, or<\/li>\n
      2. Guide their patients to achieving their goals in fewer sessions.<\/li>\n<\/ol>\n

        And asking providers to do both of those things in the current reimbursement environment would be\u2014financially-speaking, anyway\u2014just plain laughable. As Benz notes in the above-cited article, \u201cThere is no consideration of the medical value to the patient for a given service nor is there any incentive to minimize costs. As a result, incentives are heavily misaligned and skewed towards the overuse of complex and therefore costly procedures as opposed to encouraging the use of effective procedures, some of which may be low cost to deliver.\u201d<\/p>\n

        Federal Policy: The Fast Track to Pay-for-Quality<\/h3>\n

        Bottom line: With the cry for lower healthcare costs louder than ever, it\u2019s clear that the status quo won\u2019t be the status quo for long. When it comes to payment reform, the proverbial ball started rolling years ago. But in 2015, it got a major turbo boost when the US Department of Health and Human Services (HHS) announced its goal to:<\/p>\n