Payments focused on value are imminent. For successful value based purchasing, you will need to be savvy with what risk adjustment entails. If you do not understand the concept of risk adjustment, your payment future is at risk.
Myth 1: Payers adequately risk adjust subscribers for the purpose of paying rehabilitation providers for quality service.
No! Payers risk adjust based on claims data: age, gender, diagnostic codes, treatment codes, previous health spending and prescription data. The purpose for risk adjustment is to predict subscriber cost. Payers do not have the specific data required to adequately risk adjust your patients for value based purchasing.
Myth 2: Every outcomes measurement system uses the same risk adjustment factors.
Definitely not! Before you implement an outcomes measurement system, educate yourself on the risk adjustment factors incorporated into the system. Systems are not equal.
Myth 3:Risk adjustment factors are weighted the same.
Oh my, no! Each factor has its own weight and is factored into an algorithm.
Myth 4:A system that includes risk adjustment is not able to explain the variance in outcomes between patients.
Wrong! If the scientific work has been done, there should be data that indicates the variance explained. The higher the percentage, the better the risk adjustment algorithm. If the risk adjustment metrics can only explain 5-10% of the variance in outcomes, you need to find a better outcomes measurement system. That low of a percentage typically means age and gender are the main risk adjustment factors. You deserve better - your payment future depends on it.
Myth 5:Risk adjustment isn't that big of a deal.
Without risk adjustment you could be penalized, even if you are providing high-quality care. If you treat more complex patients or patients who have chronic long standing conditions, it may take longer for your patients to achieve goals OR there may not be as high amount of change compared to your peers who do not treat a similar patient population. Without adequate risk adjustment, you are not protected in these circumstances.
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.
Is there a Myth #6? If there is, definitely enlighten me!