The days of capturing outcomes for the sole purpose of using the results for the patient in front of you will be extinct by 2018. Currently 40% of all physician and hospital payment models incorporate “value based” components.1 For rehabilitation professionals, the conversation revolving around payment models and contract negotiations includes a component of value.
To lead in any conversation focused on bringing value based purchasing into a payment model requires two factors. Firstly, you need to fully understand the payer’s perspective. Secondly, you need to have a large amount of analyzed data at your fingertips.
Historically, you never had a need for a highly sophisticated process when you negotiated for payment. Your only data requirement focused on utilization of services for defined categories of patients. If you knew the number of visits in which you could provide your care, this was stellar information. You had a higher level of power when it came to negotiating for payment.
For rehabilitation professionals, value based purchasing encompasses far more than just number of visits. What information is needed to help you successfully negotiate payment revolving around the quality of care you provide? The level of patient satisfaction with services, the amount of functional change that occurred and the number of visits for the episode of care should all factor into a value based payment model. Even more than that, you should know cost of episodic care. On the flip side, it is also imperative that the payer provide data. You can't understand the payer's perspective until you analyze their data.
In order to have the necessary data at your fingertips, you will need a system in place to capture, analyze and report the data in a usable format. Your electronic medical record can be a great system to help you meet documentation compliance, house what occurred during an episode of care and assist you with the financial health of your business. When it comes to value based purchasing, your electronic medical record is no longer the system of choice. You need a full-fledged system specifically aimed at providing you the measurement tools, analytics and reporting capability to immediately inform you on your clinical performance metrics.
To be prepared for value base purchasing requires an outcomes management system. The outcomes management system needs to be macro-level oriented versus micro-level oriented. A system designed with a broad big picture focused on all physical therapists typically will be more robust than a system designed in-house. An in-house system reduces outside stakeholder trust, is not able to nationally benchmark and will substantially increase your costs due to the time involved not only in capturing the data, but in analyzing and reporting the data.
Speaking of data, it will be highly likely that value based purchasing will be based on aggregated data. This means that the future payment models will not be based entirely on the individual patient sitting in front of you. Aggregated data is a whole different beast. When basing payment on aggregated data, the most important element you need to strive for is equalizing all your patients. Equalizing is done by risk-adjustment. If an outcomes system does not risk-adjust the data, you run a huge risk of not capturing the full value of the services you provide therefore reducing your ability to capture higher payments.
Your track record in providing services captured via your outcomes management system will be the key necessity as you move into value based purchasing discussions. What data do you have at your fingertips now? Is it the right data to help you lead in value based purchasing discussions?
FOTO Team has compared the currently available options on the market today.
12014 Catalyst for Payment Reform, “National Scorecard on Payment Reform.” Viewed 11/6/2015