Among hospitals that currently are participating in an accountable care organization (ACO), the top 3 challenges they encounter are reducing clinical care variation, reducing the cost of care, and developing and maintaining a common culture among the various ACO partners, says a new issue brief by the Commonwealth Fund. Increasing the size of the covered patient population, developing an information system infrastructure, and accessing capital to invest in the ACO model are the top concerns of hospitals preparing to participate in an ACO.
As of summer 2012, 154 groups are participating in ACO initiatives sponsored by the Centers for Medicare and Medicaid Services (CMS). Thirty-two organizations have signed contracts to become Pioneer ACOs, 116 organizations have enrolled in the CMS Shared Savings Program, and 6 have joined the Physician Group Practice Transition demonstration program. In all, more than 2.4 million Medicare beneficiaries are receiving care from providers participating in these initiatives.
Numerous other organizations have contracts with private payers that include many of the key features of the ACO model. A recent report identified 221 ACOs in 45 states as of May 2012. This number includes both CMS and private sector ACOs.
Nineteen percent of hospitals participating or preparing to participate in an ACO report using predictive tools to identify patients at high risk of poor health outcomes or high resource use, compared with 9% of those not exploring the ACO model. Further, 28.4% of those participating or preparing to participate in an ACO report managing high-volume, high-cost patients using experienced case managers, compared with 19.5% of those not exploring the ACO model.
Only 50% of hospitals currently participating in an ACO track performance data; the other half plans to do so within the next 3 years.
All hospitals—regardless of whether they are participating in ACOs, in planning phases, or not considering the model—expect an average 11% decrease in the percent of their revenue coming from fee-for-service payments in the next 3 years.
Check out what your peers are saying about physical therapy and ACOs on APTA's collaborative care models communities discussion forum. Visit the collaborative care webpage for information and resources on ACOs, bundled payment models, and patient-centered medical homes.
The Centers for Medicare and Medicaid Services (CMS) recently launched an interactive map to help providers determine state-specific organizations that provide Medicare auditing and compliance services. The map includes contact information, e-mail addresses, and websites for state organizations. It also features the CMS divisions responsible for contractors and definitions of contractors and their roles.
Two new APTA podcasts provide guidance to physical therapists (PTs) regarding the distinct approaches of hospice and palliative care services and the role that physical therapy plays in treating individuals in those situations.
The first podcast clarifies the 2 terms "hospice" and "palliative" based on Medicare's conditions of participation guidance published June 5, 2008, in the Federal Register. It also highlights APTA's position The Role of Physical Therapy in Hospice and Palliative Care, which was adopted by the 2011 House of Delegates.
In the second podcast, Chris Wilson, PT, DPT, GCS, describes how patients in acute care can experience rapid changes in the ability to perform activities of daily living and why regular monitoring and intervention by PTs may be required. Wilson, who provides acute care physical therapy service in the Hospice and Oncology Unit and outpatient oncology services at Beaumont Health System near Detroit, Michigan, also explains the role PTs may play in determining when less-aggressive measures, such as hospice or palliative care, may be appropriate for patients. Additionally, he addresses the need for PTs to consider the big picture and respect a patient's autonomous decision to decide what care is best—particularly when a patient opts to come off hospice care in order to qualify for a nursing home stay or rehabilitate to improve his or her strength to be able to return home.
Find more information on this topic on APTA's Hospice and Palliative Care webpage.
Several leading primary emergency department (ED) diagnoses have the potential for physical therapy triage and possible treatment, according to a new APTA resource that members can use with facility administrators or ED staff to illustrate the value of physical therapy in the ED. Developed by the member experts who created the Incorporating Physical Therapist Practice in the ED: A Toolkit for Practitioners, this new PowerPoint outlines recent ED trends, potential benefits of having physical therapists (PTs) in the ED, and how ED PTs can improve patient satisfaction and patient function and outcomes.
APTA members can download the PowerPoint and tailor it for their specific presentation needs. Find the Value of Physical Therapy in the ED PowerPoint and other resources on APTA's Physical Therapist Practice in the Emergency Department webpage.
"Despite the controversy over the entry of retail clinics into chronic disease management," say authors of a new study published online in Health Affairs, less than 1% of visits through 2009 were for chronic disease care.
The number of patient visits to retail clinics grew from 1.48 million in 2006 to 5.97 million in 2009. Preventive care—in particular, the influenza vaccine—was a larger component of care for patients at retail clinics in 2007-2009, compared with patients in 2000-2006 (47.5% versus 21.8%). Across all retail clinic visits, 44.4% of visits in 2007-2009 were on the weekend or during weekday hours when physician offices are typically closed.
From 2000-2006 to 2007-2009, the proportion of retail visits made by children under age 18 decreased, from 26.8% to 22.2%, while the proportion of visits made by those 65 or older increased, from 7.5% to 14.7%. In both study periods, 30%-40% of the patients who visited a retail clinic paid for their care out of pocket and reported having a primary care physician.
Acute care visits made up a smaller proportion of overall visits in 2007-2009 than in 2000-2006. The same 9 conditions accounted for the vast majority of acute care visits in both time periods. The distribution of acute and preventive care visits was similar for children and adults under age 65.
The authors say that the "rapid growth of retail clinics makes it clear that they are meeting patients' needs." They believe that the chief drivers are convenience, after-hours accessibility, and cost effectiveness.