FOTO and payers know the current payment model for rehabilitation services will change in the very near future. New payment models will include a combination of risk sharing and Pay for Performance. Both hinge on the level of quality of the service provided.
FOTO is leading the way in collecting and aggregating data. The FOTO system is unique with its thorough algorithm validated in peer reviewed research. FOTO risk-adjusts data based on a set of factors known to impact rehabilitation outcomes. The process involved in capturing data utilizes advanced technology to improve the validity and reliability of each patient's individual data. The FOTO system is robust enough to nationally rank providers based on their outcomes. FOTO focuses on the Triple Aim in Rehabilitation by measuring effectiveness, efficiency and satisfaction.
FOTO is pleased to announce a partnership with two new payers: HealthPartners in Minnesota and Blue Cross Blue Shield of Louisiana. Both payers are creating new payment models highly focused on Pay for Performance. Additionally, FOTO is providing outcome reporting to Blue Cross Blue Shield of Michigan in a pilot study for similar purposes.
Although Pay for Performance seems to be a new alternative to the current fee for service payment model, FOTO is the industry leader in knowing the value of quality services. FOTO led the rehabilitation industry by describing Pay for Performance in 2006 via a report to CMS titled, "Pay-for-Performance for Physical Therapy and Occupational Therapy: Medicare Part B Services."
When FOTO partners with a payer, hardly anything changes from a day to day payer perspective. The payer is responsible for only a few additional duties. The payer establishes criteria defining provider payment categories. The payer communicates the alternative payment model to their providers and requires participating providers to use FOTO. Lastly, the payer assumes the responsibility for issuing incentive payments to the participating providers.
FOTO assumes the responsibility of aggregating the data and compiling a report to the payer. The report simplifies the process for issuing incentive payments. The FOTO report provides a percentile ranking of the providers that places the providers in a payment category according to criteria established by the payer.
One of the important aspects of the partnership is the fact that FOTO is viewed as an independent provider of information. Both providers and payers view the FOTO reports as unbiased and accurate. Both parties accept the FOTO reports with greater assurance that the data is in no way compromised by one party or the other. In addition, both parties understand how the data is collected, reported and used in administration of the program. Program integrity is therefore enhanced and ensures acceptance by all concerned.
Until next time,