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FOTO Rehab Outcomes Blog

Revamping Value Based Payment

I love this quote from Charles Kahn. "The refocus begins with targeting measurement to capture what matters most, minimizing burden, and adapting to a transforming delivery system that strives to clinically integrate care."

Recently Charles Kahn wrote in the Health Affairs Blog about reexamining and refocusing  efforts on value-based payment models.  I'm sure all of us in the rehabilitation world whole-heartedly agree. For years, all we've reported are codes and modifiers that have no meaning or relevance about what matters to the patient from a rehabilitation perspective. All we've been doing is reporting to comply.

The mandatory functional limitation reporting has many problems. There is no value in the data. One reason, unless a clinician is using something like FOTO, there will be little to no consistency determining the anticipated discharge goal. Every clinician can guess or hope what the final discharge level of function will be. Our brains aren't capable of quantifying our clinical experiences which means relying on our memories will result in substantial inconsistencies. Another very huge reason the data will be horrible is because almost every patient reported outcome measure and performance measure has been converted to some level of percent disability. The psychometric properties and the design of some of the measures have nothing to do with functional ability.  We've unscientifically altered what some measurements measure. Can you guess another reason? The reporting does not include a risk adjustment process. Although functional limitation reporting is focused on the individual patient, stakeholders will not be analyzing n=1. Stakeholders will be analyzing and basing conclusions on aggregated data. The aggregated data will be used to determine the level of care clinicians or organizations provide.

What matters to patients? There are plenty of things that probably matter.  Bottom line: they want clinicians who care and those they 



can trust. They want results. The typical results they will want: the highest level of function possible as quickly as possible.

Maybe the whole "value based" concept will be revisited. Once stakeholders learn the current functional limitation reporting data is worthless, may something better be designed. May that something be appreciated by the majority. The wheel doesn't have to be reinvented.  Patients want to improve as much as possible in the shortest amount of time. FOTO's measurement system is sensitive enough to capture change. FOTO already knows that its system can adequately benchmark organizations

Until next time,