P4P Redux-Consider the Source

From the Medinnovation blog, a good piece on the perspective of P4P initiatives.    Seems like all of the SCHIP talk and the impact on therapy caps, fee schedule, and exception process has negated any momentum on P4P measures in PT-and for this I am thankful.

I have contended that P4P is:

1. A buzzword without any clear definition and therefore more “feel good” than substantive.  Like all buzzwords and fads, it too shall pass.

2.  Any attempt at P4P in PT will only increase our administrative cost of providing service and compliance will be so poor and inconsistent that anything meaningful gleaned will be suspicious.

3. P4P is really pay for non performance or to use Regina Herzlinger’s phrase, “pay for conformance”.  The quality indicators that are typically done in the P4P trials are metrics that do not translate well to PT.

Seems that the perspectives as pointed out on the blog piece tell an interesting story with clear differences in success.

 

Larry

Comments

[al amato]

Another perspective on P4P;
Larry has made some interesting observations regarding P4P in Health Care. When applied to physican services, he is mostly right that metrics used are process measurements and therefore inadequate to measure patient response to care. However, in rehabilitation there are quite a few instruments that are valid functional outcome measurement tools. These instruments focus on function and satisfaction.
FOTO, Inc has published a pilot study for CMS on the use of outcomes to deveope a P4P methodology for outpatient rehabilitation providers under Medicare.
This study proved the concept that an outcome based P4P system can be efficiently applied. The key is the outcome tool must be able to predict utilization and functional change, be risk adjusted so that it applies to any and all patients and be efficient to administer. By comparing intake and dischage patient responses, the P4P process can be applied to pay providers for individual patient outcomes.
CMS is under Congressional mandate to replace the current reimbursement CAPS and MEDPAC as well as other agencies are recommending moving to a P4P payment model. Over 1/4 of Health Insurance Co have P4P programs in place for hospitals and Physicians. Cooper Waterhouse just published a position paper that identified P4P will be the major way payers reimburse providers in 5 years. FOTO, Inc already has its first payer collecting outcomes from outpatient providers, and is expected to move towards a form of P4P in the near future. FOTO, Inc. experience is that the right outcome tool can be fairly and accurately applied to P4P in outpatient rehab.
The momentum is moving toward P4P. I think it imprudent that this trend be ignored. At the least, consider collecting outcomes to be able to compare your care to a national average. Its good information that can be used for marketing and staff development.
Al Amato, PT, MBA

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