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FOTO Rehab Outcomes Blog

What's a Key Component in Alternative Payment Models?

As I read the article I'm choosing to share with all of you, I realized that I have a "me" mentality when thinking about alternative payment models. "Me" meaning if "my care" is exceptional, then I should receive better payment for "my services." 

Sure, alternative payment models should focus on quality and increasing payments for quality. The article I read brings another very important factor into the equation. When an alternative payment model is designed, prior to initiating the model, an important question needs to be answered. Will the process be able to differentiate high performing clinics from low performing clinics? 

In 2012, Centers for Medicare and Medicaid listed the functional measures that are acceptable to be used by rehabilitation providers. The rehabilitation outcome measures included the Activity Measure for Post‐Acute Care, the American Physical Therapy Association's “Outpatient Physical Therapy Improvement in Movement Assessment Log” measure, the American Speech Language and Hearing Association's National Outcomes Measurement System and FOTO. 

When Centers for Medicare and Medicaid Services outlines an alternative payment model that includes a rehabilitation outcome measure, there is research supporting FOTO's measures.

Below you will find a quick view of the abstract.


Benchmarking Outpatient Rehabilitation Clinics Using Functional Status Outcomes.




To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics.


Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments.


Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-June 2008. FS at discharge was modeled using hierarchical regression methods with patients nested within therapists within clinics. Separate models were estimated for all patients, for those with lumbar, and for those with shoulder impairments. All models risk-adjusted for intake FS, age, gender, onset, surgery count, functional comorbidity index, fear-avoidance level, and payer type. Inverse probability weighting adjusted for censoring.


Functional status was captured using computer adaptive testing at intake and at discharge.


Clinic and therapist effects explained 11.6 percent of variation in FS. Clinics ranked in the lowest quartile had significantly different outcomes than those in the highest quartile (p < .01). Clinics ranked similarly in lumbar and shoulder impairments (correlation = 0.54), but some clinics ranked in the highest quintile for one condition and in the lowest for the other.


Benchmarking models based on validated FS measures clearly separated high-quality from low-quality clinics, and they could be used to inform value-based-payment policies.

  2016 Apr;51(2):768-89. doi: 10.1111/1475-6773.12344. Epub 2015 Aug 6.

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