As I was looking at my company's profile data, my gut dropped when I saw how many of the patients treated have a lot of co-morbidities. My initial gut response was a bit of worry. You see, I am categorized as an individual provider by a company called Evicore. Evicore has a contract with Blue Cross Blue Shield of Michigan to categorize the level of care I provide to patients. Evicore is also contracted to be a gatekeeper and provides authorization for physical therapy services based on a provider's category.
My initial gut response was because Evicore doesn't really base a provider's category on a strong risk adjustment process. If my patients take more time to achieve outcomes, how can I 1) show that my patients are different than the typical practice and 2) provide real outcomes of care for patients who have a specific payer?
Do you know how you can use FOTO to be your defender?
FOTO recently updated your report portal to help you visualize your data. Your dashboard has multiple ways in which you can analyze how well you are delivering your services.
We all know payers have data on providers. For rehabilitation services, Medicare B has visits, functional limitation codes and cost for every provider or organization. I've voiced my concern with how clinicians are using measurements to determine functional limitation codes. Let's fast forward to 5 years from now. What if Medicare B takes the functional limitation codes and modifiers and begins to base payment on those modifiers? Do you believe the current reporting system is an acceptable process for determining level of payment?
If you use FOTO, you have FOTO as your defender. You can now look at your dashboard and filter your data to analyze based on payer. If Medicare B were to rate my services as not providing enough functional change to be considered valuable, do I have data to defend the quality of care I provide. With FOTO's recent update, I can honestly say that I can defend my stance that the care I provide either meets or exceeds what is expected to happen with services.
The combination of filtering and clicking the percent rank number to have an immediate utilization grid pop up for easy viewing provides your defense right at your fingertips. By providing the additional data, you can learn which box each patient in a particular care type fall into so you can learn where you need to focus to improve the care you provide. This pop out can be used to define your clinical performance. Your goal should be to see most patients fall in the green and yellow colored boxes.
If a payer has poor processes defining quality, FOTO is your defender. Have you seen the changes in your dashboard?
Until next time,