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.
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!
Until next time,