FOTO Rehab Outcomes

Part 4 - Outcomes Conference Wrap Up: Who Said This?

Written by Selena Horner | May 17, 2016 9:30:00 AM

Today's post focuses on a couple of sessions focusing on how to use rehabilitation outcomes from a business perspective: negotiating contracts. One of the cool aspects of FOTO's Outcomes Conference is how it brings together three aspects of outcomes: business, research and clinical.

Last week I published the third in a series about the outcomes conference. 

Who Said This?

If you guessed Dan Fleury at Pinnacle Rehabilitation Network, you are correct! 

Dan shared all three elements of a perfect story - a true story. He introduced the prevalence of Accountable Care Organizations (ACO). He shared the impact ACOs had in a local region. This impact led to a huge conflict and struggle. When an ACO begins to dominate in your area, you have to figure out a way to be included in negotiations. He pulled me into his story emotionally by sharing the excitement of having a seat at the negotiating table which ended in disappointment and failure. Being asked to leave the negotiating table had to have been rough. His story didn't end with failing. Failing led him back to the drawing board. A slightly different solution became apparent. He found an entity that was very, very similar to an ACO and he was able to gain a seat at the negotiation table. This time the organization listened. This time the organization was interested in details revolving around rehabilitation services: number of visits, cost per visit, change in function and satisfaction. To me, there is nothing better than a happy resolution. A very large national provider was kicked out of the relationship and PRN became the new provider. At the end of one year, PRN saved $750,000.00 in medical spending. The buzz from that result created multiple opportunities with other payers and assuming hospital contracts to provide rehabilitation services. 

Who Said This?

If you guessed Seth Kaplan at Baton Rouge Physical Therapy-Lake, you are correct! 

"The new idea either finds a champion or it dies. No ordinary involvement with a new idea provides the energy required to cope with the indifference and resistance that change provokes." - Tom Peters.

For years Seth and PTPN met with Blue Cross Blue Shield Louisiana to encourage Blue Cross to change how rehabilitation providers were paid. Although the concept of pay for performance was introduced, it was too new in the payer world. In January 2013, Al Amato (President of FOTO) joined Seth in discussing a new payment model that would add value to Blue Cross's current 3-D focus (Diagnosis, Dollars spent, Days treated). A 4th D was required: Disability. Unknowingly to Seth and Al, Blue Cross finally understood. In May Blue Cross responded by implementing a 3% cut in the fee schedule for rehabilitation providers. Now that doesn't sound like the desired response, does it? Well, in October of 2013, Blue Cross decided to implement a Pay for Performance model: Quality Blue. All rehabilitation providers who chose to use FOTO had an opportunity to not feel the 3% cut in the fee schedule IF they provided care at the expected outcome or better. Quality Blue required 1) having a full set of data for 60% or more of the Blue Cross beneficiaries treated and 2) providing care that met or exceeded predicted expectation. If care was provided at the expected outcome, the provider would receive an extra 3%... if the care provided exceeded the expected outcome, the provider would receive an extra 6%. 

Seth, PTPN and Al found a champion with Blue Cross. Their idea didn't die... it was used to create Quality Blue.

In the event you are curious about presentations from previous years, you can find them here. I have LOTS more to share from the most recent conference! Stay tuned!

Until next time,

~Selena