The Road Less Traveled

Originally posted on on 3/30/2016
By APTA President Sharon L. Dunn, PT, PhD, OCS
Anyone delivering care in the current environment can see the evidence of change ahead. We know that care delivery in a few years—even later this year—will look vastly different from how it looks today.
In fact, some changes are already here. Medicare will flip the switch on its Comprehensive Care for Joint Replacement Model (CJR) on April 1. Providers serving patients with TKA or THA in 67 US regions will be impacted by this collaborative bundled care model, which will change the way providers, including PTs, are paid. And that is just the beginning.
So, why the drive toward change in health care? It’s all about the value-vs-volume equation. Payment decisions are rightly being driven by how to provide value-based care to our patients, rather than by the volume of services provided. It’s a change we sorely need.
We can’t—and often shouldn’t—oppose change, but we can—and should—be involved in advocating for our profession as a part of the change. That’s not always a clear path. Deciding which road to travel involves a lot of planning and strategy, with the hope that the environment also delivers a healthy side of opportunity that we can seize.
Of course, seizing opportunity to move the profession forward, to aid our transformation, isn’t without risk. But there’s an even greater risk: not acting and having someone else decide our path. That’s the philosophy that drives APTA to take a proactive approach to payment reform and, more specifically, toward working with collaborators among our members and other provider stakeholders to reform the way physical therapists code services.
So let’s keep thinking about how we can position ourselves for the long-term changes, but let’s also prepare for the changes at hand, especially the 2 big changes coming this year. We want to make sure you are ready. First, make sure you understand what the CJR is and how it will affect you. Second, educate yourself on the new evaluation codes coming January 1, 2017, and the thinking (and process) behind their creation. Here are some resources that can help:

  • A perspective from Physical Therapy on understanding bundled payment models
  • An webpage dedicated to CJR resources that includes a free webinar for APTA members
  • An article on payment reform from the April issue of PT in Motion magazine
  • The 3-part WebPT series on APTA’s payment reform efforts (which we didn’t write but think it’s important to share as part of APTA’s commitment to cover different perspectives with you as we prepare for what’s ahead): Part 1, Part 2, Part 3
    Health care is evolving, and our profession has a transformational vision. That’s a lot of change to keep up with. But I know this profession and this association, and I’m sure that in partnership with one another, we can take on the road before us.
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  • Of course we can- and often should- oppose change, particularly if that change is driven by just another re-formulation of top-down control over how healthcare services are provided. Does anyone really believe- after over 6 decades of Medicare moving inexorably towards insolvency while compliance rules and documentation requirements have grown increasingly onerous- that the bureaucrats in DC will be able to come up with an efficient and value-based way to reimburse for care? To think that provider input to CMS (which will process all the often conflicting interests of the various providers through the political filter that invariably influences all central decision-making and then spit out some predictably incomprehensible, unfair and inequitable reimbursement scheme on the other end) is going to work out well for PT, I think meets the conditions for insanity: doing things the same way and expecting a different result.
    So, everyone dutifully spend the next 2 hours reading all of Dr. Dunn’s links so we can figure out how to battle for table scraps with all the other conservative providers of care. Here we go again…

    John Ware (@JohnWarePT) April 12, 2016 11:16 am Reply
  • And another thing… 😉
    I think APTA-along with all the other Washington DC-area based professional organizations- has become part of the political establishment machine. It’s a “go along to get along” mentality up there where the crafty lobbyists and well-healed PACs have become indistinguishable from the politicians they are constantly trying to woo. Is it any surprise that the DC metro area has one of the highest per capita incomes in the country? Maybe APTA needs to do some downsizing and de-centralizing of its own. I don’t know how that would look, but maybe they could start by moving the HQ to Peoria or someplace like that. I don’t see how anyone can consistently act in good faith on behalf of a profession that is trying to provide care to suffering human beings while wading in that cesspool of corruption and waste. The stink has got to rub off- and I think we have plenty of empirical evidence to show that it has as reimbursement continues to shrink, student debt continues to rise, and APTA dues remain as high as ever.

    John Ware (@JohnWarePT) April 12, 2016 2:12 pm Reply

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