How Physical Therapists Can Add Value to Medicare Accountable Care Organizations

Private practice physical therapists in Florida who understand Medicare Accountable Care Organizations (ACO) are scared about the coming changes in healthcare financing.

But, like many large-scale changes ACOs will bring opportunities for success as well as threats to your current business model.

I'm discussing strengths, weaknesses, opportunities and threats of the ACO model today, August 10th, 2011 at the Florida Health Care Coalition Sixth Annual South Florida Conference Empowering Healthcare/ Engaging Consumers in Ft. Lauderdale, Florida.

Lessons learned here today that physical therapists in private practice can take home:

• Insurance company employees are patients, too. They want better access, process and outcomes of care than they are getting now.
• Wellness and Coaching are proven, albeit expensive, alternative model of chronic care delivery. "Expensive" is relative to the cost of people just taking care of themselves though better diet, exercise and controlling addictive or compulsive behaviors.
  
• Improving behavior is also a proven strategy to lower costs. Whose behavior needs controlling? Patients need better strategies for managing their personal behaviors. Providers need more accountability for our workplace behaviors.
  
• Behavior change skills are fundamentally different from physical therapists' traditional focus on "patient education".
  
• Primary care physicians will be reimbursed for providing wellness care (eg: exercise prescriptions and interventions).
  
• There is a problem with "rouge specialty physicians" driving up costs by performing too many uneccessary procedures, especially in South Florida.
  
• A short-term cost saving strategy will be to increase screening of healthy populations for high-cost, common conditions, like future falls risk in elderly people, comunity-acquired pneumonia and depression in post-surgical patients.
  
  Physical therapists can provide these screenings.
  
• Some insurance companies are experimenting with influencing patient behavior using social media, like Facebook and Twitter.
  

Learn more about Medicare Accountable Care Organizations at the FLorida Physical Therapists in Private Practice (FLPTPP) seminar How Physical Therapists Can Thrive Under Healthcare Reforn in Orlando on August 20-21, 2011.

Sign up now at the FLPTPP website.

You can sign up for the 2-day, 14-CEU seminar here using the web form at the FLPTPP website or you may also register by calling either one of these phone numbers:

1.813.874.2500 (office)

Toll Free: 888-MSK-4331

The course is being held at the Lake Buena Vista Embassy Suites. The Reservation phone number is (407) 239-1144. Ask for the $85 seminar pricing.

Medicare Accountable Care Organizations May Help Physical Therapists

New guidelines for Medicare Accountable Care Organizations (ACO) may help physical therapists become more important players in America's healthcare system.

However, physical therapists are currently not categorized as ACO professionals by the Secretary of Health and Human Services (HHS).

The new guidlelines will, hopefully, add clarity to vague promises and hopeful expectations currently voiced by Medicare officials:

"An ACO will be rewarded for providing better care and investing in the health and lives of patients," said CMS Administrator Donald M. Berwick.

"ACOs are not just a new way to pay for care but a new model for the organization and delivery of care."

Leaders in the commercial healthcare marketplace are more forthcoming. Karen Ignani, CEO of America's Health Insurance Plans, said ACOs presented...

"an opportunity for Medicare and Medicaid to build on the successes of the innovative payment systems that exist in the private marketplace today to improve the quality and safety of patient care and help put the health care system on a sustainable path."

I can't help but think that Ms. Ignani was speaking of innovative delevery models, like the Virginia Mason experiment from 2006, where patients with lower back pain went first to physical therapy, skipping the expensive MRI and neurosurgical referral.

Virginia Mason makes sense except in the current econoomic model: fee-for service.

Fee for service rewards greater productivity but not innovation.

The more cost-effective Virginia Mason became, the bigger financial hit the medical center took.

"Everyone gained but Virginia Mason," says its chief of medicine, Robert Mecklenburg.

The promise of the ACO model is more experimentation like Virginia Mason but the risk is that providers will try to consolidate to gain market share and drive up prices.

Again, Karen Ignani:

"...ACOs could accelerate the trend of provider consolidation that drives up medical prices and result in additional cost-shifting to families and employers with private coverage.