Healthcare 2.0
For a fascinating read on various potential reform measure, strongly suggest you read From Volume to Value, a publication of Network for Regional Healthcare Improvement (NRHI).
It raises some strong arguments and potential solutions for various solutions in an attempt to get away from a fee for service system bent on procedures to producing outcomes.
The most relevant examples for PT include two examples that really are offshoots of capitation (they refer to as Capitation 2.0) including Episode of Care and Condition Specific. These examples try to mitigate the huge traditional risk component in capitation.
The Episode of Care example although not new is one whose time may be coming given lots of momentum at the federal level. The easiest case to think of would be to reimburse a hospital for the entire chain of events-pre/post surgery, the surgery itself, prosthesis, rehab, etc. The reimbursement from the insurance company is determined by the outcome-some aspect of a calculation that takes into account infection and complication rates, range of motion after rehab (yikes!), with some acceptable outcome instrument playing a role. This “episode of care” capitation is highly dependent on integrated systems working together. This poses some rather interesting questions and dilemmas given lots of systems unfolding their integration attempts over the last several years due to financial viability (hospitals unloading their home health agencies). Where does private practice PT fit into this?
The second example of Condition Specific certainly makes intuitive sense. A primary care physician is paid for managing a patients diabetes throughout a defined period of time (perhaps years). A global payment is made, a patient’s monitoring and tests are part of that fee, and outcome goals that meet certain parameters (e.g. blood level of hemoglobin) may result in a bonus.
Would this work in garden variety low back pain? A primary care physician or PT is paid for non-operative care to include defined outcomes? How can we best play in this game?
There is an enormous effort on cost of care and episodic care. Might just become the newest rage and buzzwords as the “solution’ to healthcare. Stay tuned.
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