The payer mix has been slowly changing over the years. As you can see in the following image, federal payer growth is increasing. Concurrent with this change is a change in payment models.
Medicare seems to be taking the lead when it comes to new payment models focused on quality of care. If we trust what typically happens in the industry, new payment models focused on value based care will become the norm for all payers. What will the model look like for rehabilitation providers? Fee for service will be extinct. Change is on the horizon.
Although change will not happen overnight, change is happening. For the last eight years, FOTO has been involved in discussions with payers across the nation. Discussions are focused on assisting with the development of new payment models focused on quality and value. Provider networks are including quality initiatives in contract negotiations. There has also been an increase in individual providers negotiating with third party administrators.
When it comes to value base purchasing, the first hurdle is knowing what to measure to know value is provided. In the rehabilitation world, the first hurdle isn't as difficult as compared to the rest of the medical world. In the rehabilitation world, clinicians typically focus on improving function. Payers reward for care that is effective, efficient, satisfying, and cost effective with no cherry picking. Often times clauses are implemented into contracts requiring a high percentage of patients to have complete data sets.
In order to be ready for value based purchasing, success in your future will depend on 5 factors.
Implementing a system to measure your quality - It won't be enough to only have your electronic medical record as the tool that houses your data. You'll need a system that is able to provide the required data to the payer.
Measuring and tracking your results over time - You will need to know your exact results at any moment in time. It will no longer be conducive to track results on an annual basis. An annual basis will be too late for you to make any changes to improve performance.
Analyzing results - Practical understanding of the data will enable you to pinpoint lower quality of care, assist in determining the cause, learn from top performers and focus on creating the necessary change to meet quality parameters.
Reducing your operating costs - Streamline your operations from both a patient care perspective and from a business perspective. Have the right systems in place to reduce your work load. Automate processes whenever feasible.
Implementing ways to increase patient volume - As your quality of care increases and you become efficient, you will need to capture a higher volume of patients in order to maintain a steady flow of revenue. Create a strategy for this future trend.
This week FOTO Team will be excited to see many of you at the American Physical Therapy Association's Combined Sections Meeting in Anaheim, California. Stop by Booth #259 to better understand why FOTO is the standard in outcomes measurement. In the event you are really curious, no worries, I can share a bit here for you. Just click and learn more.
Are there more than 5 necessities for successful value based purchasing contracts? Let me know if I'm missing something!