Payers adopt PTPN’s first-of-its-kind “Pay for Outcomes” program to identify and reward high-performing rehabilitation providers

With PTPN ROI (Rehab Outcomes Index), payers know their members are getting the best care for an efficient recovery.

 
PTPN, the country’s first network of rehabilitation professionals in private practice, today announced the adoption of its “Pay for Outcomes” program by three of its largest contracted health plans.

The program rewards and recognizes providers who meet the highest standards in getting patients better efficiently. The incentive plan is based on the PTPN ROI (Rehab Outcomes Index), the first comprehensive quality report card for outpatient physical therapists (PTs) and occupational therapists (OTs). Providers who earn the incentive are paid on fee schedules ranging from 5 percent to 12.5 percent higher than normal.

“We recognized that the healthcare industry is replacing ‘pay-for-performance’ with ‘pay-for-outcomes,'” said PTPN President Michael Weinper, PT, DPT, MPH. “Medicare and private payers are increasingly linking reimbursement to patient outcomes as an incentive for providers to improve quality of care. Healthcare reform and regulatory provisions are also calling for providers to be accountable and transparent about outcomes and other quality measures.

“Anticipating these changes, PTPN began measuring outcomes for our therapy offices five years ago. As an outgrowth of the PTPN Outcomes Program, we developed the PTPN ROI to assess our therapists’ outcomes data and spotlight providers who deliver the most value — those that achieve the best patient outcomes most cost-effectively,” Weinper concluded.

The PTPN ROI is a proprietary evaluation system for select contracted insurers and other payers that combines key quality and performance data on PTPN therapists into a provider report card format. With the report card, payers can reward therapists who produce the best outcomes and incentivize other providers to improve their performance. One highlight of the third-party software engine that drives the PTPN Outcomes Program is its ability to provide risk-adjusted measurements: Benchmark and outcome expectations are based on comparing a patient to the experience of similar patients — similar in gender, age, diagnosis, acuity, other health issues, and many other factors that influence a patient’s ability to improve.

The PTPN ROI comprises seven quality measures collected through the PTPN Outcomes Program, Quality Assurance Program and Credentialing Program. To qualify for a bonus from payers, PTPN offices must meet criteria that demonstrate excellent patient outcomes and lower than predicted visits. Rewarding the providers who rank highest in these categories — and therefore are the most efficient providers — saves insurers money on a per patient basis, even if the therapists are paid more per visit.

PTPN practitioners who are achieving high scores on these PTPN ROI measures use various approaches to integrate PTPN’s mandatory outcomes measurement system, powered by FOTO (Focus on Therapeutic Outcomes), into their practices. Here are a few examples of how they’re using their outcomes data in talking with patients and physicians and to improve treatment:

  • Richard Blum-Johnston, MPT, COMT, CEAS, CCI, owner, Rialto Physical Therapy Center, Rialto, California, uses quarterly outcomes reports as a self-improvement tool: “We look at patients’ responses on the questionnaire and, based on a particular diagnosis, ask ourselves why we’re getting consistently high marks in this column, but not in another column. We look to see if these results are due to treatment or to patient responsibility, and if necessary we tweak our treatment.” Blum-Johnston also uses outcomes reports for building relationships to physicians: “I ask them to take a look at their patients’ outcomes and how the patients felt about us and their progress. Some physicians will be interested in finding PTs who are motivated to do things differently with every patient to get results, and so far we have developed steady referral sources.”

  • Michael Sherman, MS, PTA, RCEP, North County Physical Therapy, Paso Robles, California, notes that he is the “designated clinical outcomes champion” in his large office, which has a culture of efficiency: “Our goal is to get people better — to make us happy, our patients happy and the doctors happy — in the quickest amount of time. Starting on the patient’s first visit, we drive home the patient education component, teaching the patient self-responsibility for their program compliance. We plan out their visits and make them accountable for getting their routines done at home. Patients like it because they don’t want to come in for therapy any more than necessary. We get excellent results in relatively few visits.”

  • Shelly Cloughley, DPT, MPT, CSCS, associate clinical director, Progressive Physical Therapy, Santa Clarita, California, said her office has a system that has increased patient participation from 25% to 75%: “We delegated the task of getting patients into the system to one person in our front office. A routine has been established to keep track of when patients need to have their status surveys completed and make sure the PT has the initial intake survey to review.”

For more information on the PTPN ROI and Outcomes Bonus Program, contact Stephen Moore, 818-737-0246 or smoore@ptpn.com.

 
About PTPN:
PTPN is the nation’s premier specialty network of rehabilitation therapists in independent practice. It has led the rehabilitation industry in pioneering national contracting and quality assurance programs since 1985. The network has nearly 1,000 provider offices (including physical, occupational and speech therapists) in 23 states. PTPN contracts with most major managed care organizations in the nation, including insurers, workers’ compensation companies, PPOs, HMOs, medical groups, and IPAs. All members of PTPN must be independent practitioners who own their own practices. For more information on PTPN, contact Stephen Moore at 818-737-0246 or smoore@ptpn.com, or visit ptpn.com.