Let's face it. We live in a culture of change. dramatic change. And nothing seems to change as quickly or dramatically as health care has since 2010 and will continue to do so over the coming years.
So what is driving, and it brings opportunities or physical therapists threats?
Let's take a look.
The drivers of the reform of health care
The Affordable Care Act. AC. "Obama Care"
The ACA has been a major source of political controversy between liberals and conservatives since it became law in March 2010, and the controversy around it seems to rise every day. More than 20,000 pages of laws, rules and regulations. New taxes and regulatory requirements more payers, providers and individuals. Consolidation of payers. The integration of suppliers. reduced refund threats. Pay for performance. Risk sharing. www.cms.gov.
With very troubled roll on health care exchanges and Healthcare.gov website on October 1st, the issues escalated. They now go beyond politics. He became staff
For patients -. Can I keep my chosen suppliers? What services are covered? What will increase my premiums? Does my employer will continue to buy my insurance
For providers such as physical therapists - How OCA plans and health providers choose therapy? my practice is going to be included, or be left out? Is that the refund be cut? Does my practice survive?
Consumers
But the reform of health care goes beyond the ACA. Change is driven by people paying the bills.
People who pay for health care are driving Change because they do not like what is happening now. It is too expensive for employers and their employees. It is too expensive for those who have to buy it on their own. It is too expensive for health plans and ACOs.
PricewaterhouseCoopers (PwC), the largest professional services firm in the world, reports that about 50% of health care costs in the US are redundant or unnecessary. Health care spending reached a huge $ 3T in 2012-8233 $ / person. If PwC is correct, we spent about $ 1.5T on services that added no value to PATIENTS. www.pwc.com. But suppliers who have delivered these services have benefited financially. The sad reality is that suppliers continue to provide unnecessary services so they have an incentive to do so in a commission for the service environment. Show me the money!
The cost of health care is unsustainable for the government, payers, employers, and individuals. All of us. This must Change . But we have obstacles in the path of change -. wrong incentives
current financial incentives - Volume Based
VOLUME fee for service awards. The more you do, the more you get paid.
It creates a SYNDROME VOLUME.
The SYNDROME VOLUME is defined by the equation
(profitable services x fee maximum x Maximum frequency) - (minimized expenditures)
in other words, find a service that has a decent profit margin and do it as much as possible to your lowest cost.
volume syndrome causes a conflict.
providers trying to maximize. Paying try to minimize it. Incentives are misaligned. Let the battle begin, and the big dog in the fight wins.
Service fee creates "Provider Centered" behavior as suppliers of all types of work "system play. Unfortunately, the behavior of providers focus is not what payers nor necessarily want what patients need. Because "provider-centered" is misaligned payer and patient needs, it is for a long conflict and long-term failure.
It becomes worse.
syndrome volume is compounded in today's environment by a vendor complacency.
syndrome complacency defined by this EQUATION
'quality' NO Consumer Choice + is easier for me to provide +
"service" which is less embarrassing for me to deliver cost + no Regard
in other words, if patients can not go outside the system, I will always be busy regardless of what level of service or quality I provide. So I will do what is most convenient for me?
CONVENIENCE more VOLUME create incentives focused supplier as far as the eye can see.
No patient-centered view. While all vendors say they are "patient-centered", but their behavior shows that they are "Centered Provider".
Now, patients are really upset. So are employers who pay for most of their health care costs. They want Change . We must move away from volume-based incentives that reward the provider centered behavior
The change to a new incentive -. Value Based
Provider centered behavior driven by incentives evil is creating a consumer revolt.
VOLUME VALUE revolt in which the incentives will start to change across a wide spectrum.
Change comes. VOLUME syndrome begins to be replaced by the value demand.
VALUE The application is defined by the equation
Measurable Quality + Customer Service + Convenient access + Caring
___________________________________________________________________
Cost of care
Now, this is an equation that all patients as. I like this. You should love. We are all patients at one time. "Patient-centered." It is about VALUE. Increase the numerator, decrease the denominator .
best quality. Best service. Best prices
He is the threefold -
Measurable Quality . | Experience exceptional patient | Lower total cost of care
Unfortunately, for the most part, we are not often motivated well enough to provide maximum value. We still live in a volume-Based, costs for worldwide service.
But the incentives are slowly starting to change .
Michael Porter, Harvard Business School, and Thomas Lee, Press Ganey, in their article visionary "strategy that will fix health care" describe how real-centered behavior patient provided through, innovative collaborative teams reduce costs and improve the quality of health care. (Http://hbr.org/search/The%20Strategy%20that%20will%20fix%20health%20care%20Porter/0).
in their white eye-opening book "the Revolution volume value", Adrian Slywotzky and principal Tom Oliver Wyman group describe many examples of value care models based because they are motivated by risk sharing , payment models based on value, improve patient health and reduce overall costs (http: //www.oliverwyman .com / volume-value-revolution.htm # .UsmsXXkRXgI).
We have experienced very positive results at Therapy Partners where we have helped networks of independent treatment practices in several states reach agreements based on the value with the results FOTO (www.fotoinc.com). They create win-win-win arrangements for the 3 P - Patients, providers and Paying . Patients receive better quality care. Therapy Services receive financial reward for the highest results. Paying may see reduced direct costs for treatment and reduce the total costs for all health care services.
related to physical therapists
Change in health care is very complex and can be overwhelming. selected physical therapists summarize ACA thousands of pages to a few key points that will bring value. We emphasize 8 Key points:
- Consolidation - you have to be large enough to attract the attention of powerful decision makers
- Collaboration - you need to collaborate with other providers to offer a broad-based health value
- patient centered - provide services / care that meets really sick - not vendor - interest
- risk sharing reimbursement models - are preparing to achieve and succeed in the risk-sharing agreements based on the value
- Triple Aim - provide quality measurable - improve overall health - to reduce the total costs
- ACOs - create relationships with suppliers with larger ACOs care systems
- patient-centered Medical Homes - to develop programs that reduce costs and improve the health of PCMHs
- innovation - be creative; think outside the box; develop new, results driven care models
Physical therapists can provide value and connect with Powers , to through Triple Aim Mission , a value Focused Culture and innovative Strategy.
physical therapists visionary main high performing teams of talented therapists have the opportunity to bring measurable value the health care delivery system, and yes. . . be rewarded for that value. The market is ripe for the value.
But you have to be a change agent. Think about it -
volume based arrangements - " The more you do, the more you do ". Value provisions based - " Deliver the triple objective, more profitable"
Look contrast for physical therapists
volume based. - more visits means more money Value based - more visits could mean less money
Volume based - The results are not considered Value based - the results are rewarded
When the financial incentives change 180 No , provider behavior must change accordingly. Difficult? Certainly, but with innovation, leadership effective and strong teams, it can be done, and it will be fun because it brings value to our patients. that is why we entered physical therapy first.
Thus is the reform healthcare a threat or an opportunity?
The answer is yours.
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Jim Hoyme, PT, MBA
Jim is one of the principal owners of OSI Physical Therapy Stillwater, Minnesota, September 1-clinical practice started in 1979. It is also one of the principal owners of Therapy Partners, Inc. (TPI), a management service organization (MSO) for 16 independent physical therapy practices with 32 clinics in Minnesota and Wisconsin.
Since 1999, TPI MOS has provided its customers with health plan contracts, managing the revenue cycle, and many other administrative services for members under one tax identification number. TPI provides operational costs lower limbs, visit payment improvement, and practice management services. They engaged in a very successful contract, based on the value using the results of FOTO with a large health plan since 2010.
TPI is positioned to extend its services to MSO practices in other states and is an excellent partner for starting practices.
Latest posts of Jim Hoyme, PT, MBA (see all)
- strategies for self-treatment practices During Changing Times - MSO- Part 2 - May 17, 2016
- strategies for self-treatment practices During Changing Times - May 10, 2016
- the 'Volume Value' change in health care: the threat? . . . ? Or Opportunity - March 17, 2014
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