How PTs can Prepare for Pay-for-Performance

You might already be aware of a certain pair of words causing a buzz in the healthcare industry: payment reform. This phrase is seemingly straightforward (at least by definition), but the implications of the concept aren’t quite as clear. What we do know is that in the US, the payment landscape is changing. As old payment models go the way of the flip phone, new ones are popping up to take their place. In fact, just a couple of months ago, the US Department of Health and Human Services (HHS) announced its goal to:

  • base 30% of all Medicare fee-for-service (FFS) reimbursements on alternative payment models by the end of 2016,
  • increase that proportion to 50% by 2018,
  • and link 85% of FFS payments to outcome measures by the end of 2016, with that percentage increasing to 90% by the end of 2018.

But what does all of this mean for PTs? Here’s what you need to do to prepare yourself for navigating the payment landscape that lies ahead:

Positioning

As a PT, your care is less invasive—and less expensive—than most of the treatments commonly used for neuromuscular injuries and conditions. And in the pay-for-performance paradigm, that is the most desirable application of care—less expensive and more efficient. Thus, positioning yourself as a patient’s first point of contact for such conditions can help you prove your value in the new payment landscape.

To position yourself as a care coordinator, you must assert confidence in your expertise. One way to do that? Embracing direct access. With some form of direct access available in all 50 states (plus DC and the Virgin Islands), you have the freedom to truly become your patients’ first point of care. If you haven’t done so already, it’s crucial that you gain a solid understanding of the laws that govern direct access in your state. Which brings me to my next point: Part of being confident is knowing your laws and being able to recognize when patient care is within your scope of practice—or not.

But to claim your rightful position as a first point of medical contact, you have to do more than just buy in to direct access. You’ll also need to properly market your practice. Why? Because even if patients have the ability to seek treatment from you first, they’re not going to do so if they can’t find your clinic information. That’s why your clinic absolutely must have a visible online presence. At the very least, that means having a clean, concise website that includes all of your clinic’s contact information. And as you market your own practice, you’re in turn marketing the importance of the profession as a whole.

Outcomes

Pay-for-performance places an obvious emphasis on value. And when it comes down to demonstrating the effectiveness of your care, you’re going to need some measurable data to do so. More than that, you’re going to need data that’s comparable and actionable. What does this mean? First and foremost, if you’re not already, you need to start tracking patient outcomes. However, simply tracking outcomes is only part of the larger picture. You also need to make a plan for how you intend to use the data. For example, you might want to use your data to negotiate payer contracts or encourage members of your community to take advantage of direct access. Outside of your clinic, your data can help protect your practice from any future payment structure penalties. As more and more clinics track outcomes, that collective data can prove the efficiency and value of PT care on a much larger scope. What’s more? It’ll empower PTs to push for legislative changes that could benefit future payment rates.

Connections

All of this planning and strategy means nothing if we don’t make our voice heard. We need to take our seat at the healthcare reform table; otherwise, we’ll leave the decision-making power up to people who don’t necessarily have our best interests at heart. To keep ourselves from getting lost in the shuffle, more of us need to get involved with PT advocacy organizations—including the APTA and PT-PAC. These groups provide a mechanism to make valuable connections—especially with political influencers. These are the folks who can help proposed pro-PT legislative initiatives come to fruition. If you’d like to take it a step further, take it upon yourself to call or send a letter to your congressional representatives and explain why they should support or sponsor of bills that benefit PTs.

 

Pay-for-performance is coming. And although you can’t stop the changes from happening, you can form a strategy to help your clinic prepare for what’s ahead. With a little elbow grease, our profession has the potential to lead the pay-for-performance pack. What are you doing to prepare? Let us know in the comments section below. Want to know more about pay-for-performance? Watch this webinar.

About the Author

Heidi Jannenga, PT, MPT, ATC/L, Founder and COO of WebPT

As Chief Operating Officer, Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for healthcare innovation, entrepreneurship, and leadership.

An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics.

Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a BS in Biological Sciences and Exercise Physiology, went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida, and recently obtained her DPT through EIM. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails.

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