FOTO®
BEGINS A PAY-FOR-PERFORMANCE FEASIBILITY PROJECT FOR CENTERS FOR MEDICARE &
MEDICAID SERVICES (CMS)
Focus On
Therapeutic Outcomes, Inc.® (FOTO®) has received a grant
from the Centers for Medicare and Medicaid Services (CMS) to test the
feasibility of implementing a pay-for-performance process in outpatient
rehabilitation. Pay-for-performance,
or value purchasing, in outpatient rehabilitation is a method of payment based
on effectiveness (patient’s functional improvement) and efficiency (number of
treatment visits).
To assess
functional status throughout therapy, patients in this study will use FOTO®’s
computerized adaptive testing process and clinicians will use the valid and
reliable data to improve patient management to pursue the best result.
As part of
the grant, FOTO® will refine and apply its risk-adjusted Value
Purchasing Payment Algorithm®,
to its robust outcomes database containing 1.6 million files, over 200,000 of
which are patients receiving Medicare Part B benefits.
Additionally, the project will collect prospective data from
approximately 150 Medicare patients treated monthly at two outpatient therapy
sites, CentraState Medical Center in Freehold, NJ and Presbyterian Health Care
Services in Albuquerque, NM, utilizing FOTO®’s Patient Inquiry
software.
Employing
both quantitative and qualitative means, the study will determine the
feasibility of developing a payment method for outpatient therapy that would
bonus providers based on effective and efficient care.
At the completion of the study, an analysis of the data collected
including the financial impact of value purchasing as well as patient and
provider experiences, will be summarized and reported to CMS.
The study has
implications for alternative payment methods under consideration by CMS and the
Congress for Medicare in general and outpatient rehabilitation in particular.
Legislation enacted in 1997 imposed a temporary per beneficiary cap for
outpatient therapy intended to be used until an alternative payment method could
be found. The cap was fully
implemented in 2003 from September 1 to December 7, and then waived by
subsequent Congressional action. The
current moratorium expires on December 31 of this year.
Dennis L.
Hart, PhD, PT, FOTO®’s Director of Consulting and Research states,
“This study is as exciting as it is
timely. Because outpatient rehabilitation lends itself so well to measuring
outcomes, basing care on need and paying according to results would implement
the Institute of Medicine’s (IOM) call for aligning incentives in health
care.” In its report entitled Crossing
the Quality Chasm, the IOM recommended aligning financial incentives with
patient management processes based on best practices and the achievement of
better patient outcomes. “Aligning
incentives in rehabilitation,” said Hart, “would provide clinicians the
incentive to pursue ways their patients can obtain the most functional
improvement (effectiveness) in the fewest number of treatments (efficiency).
Such a development promotes care that is evidence-based,
patient-centered, efficient, and cost-effective.”