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ACA, ACO, BPCI & PCMH

Collaborative Care: What does it mean for foot care practitioners working in an accountable care world?

So much has changed over the past ten years for foot health care practitioners as it relates to healthcare delivery and fee for service billing. Preventative care strategies have gone full circle.  Proactive initiatives are back in vogue under the Affordable Healthcare Act (AHA) after being buried for several years under policies geared towards reactive driven, fee for service, politically motivated Medicare cut backs. 

Sometimes as you go about your business trying to make a living in austere times, it’s hard to see the wood for the trees.

So what does it all mean for the group of foot health care professionals I collectively call POPOPPs Podiatrists, Orthotists, Prosthetists Occupational therapists, Physical therapists and Pedorthists?

The advent of Accountable Care Organizations (ACOs) responsible for working within the ACA to guarantee that healthcare is delivered to provide better quality as well as a better value for the patient has ensured that providers of healthcare work together in a collaborative environment.

Undoubtedly, this is good news for POPOPPs. Providing services and the products that promote a proactive preventable care plan rather than a reactive diagnosis for a foot health issue not only bodes well for much better quality of life metrics for the patient, but also saves money for those insuring healthcare.

But how does a POPOPP become a cog in the wheel of the collaborative healthcare continuum in an ACO world of Bundled Payment models (BPCI) and Patient Centered Medical Homes (PCMH).

The key is to think of yourself as an expert consultant for foot health care. Your customer is no longer your patient. That is yesterday’s model where healthcare providers billed a fee for service. Today, POPOPPs are selling cost saving strategies that help health insurance providers save money. That is the essence of the Affordable Care Act and the driver for Accountable Care Organizations.

The good news is that the gatekeeper to getting paid for the goods and services you are providing is not someone sat in an office incentivized to find a way not to pay you. You are marketing your services to the primary care physician,(PCP)  the physician’s assistant (PA) or the nurse practitioner (NP) that is now part of an accountable care organization responsible for providing care and outcomes and managing costs. As any business school professor will tell you, out-sourcing those services not central and key to your skill set is the most effective strategy for efficiency and time management skills. And that is where POPOPPs make an entrance on the healthcare continuum stage.  But to get on stage you have to become a member of the cast. You become a member of the cast by auditioning for the play, and, to take the analogy just one step further, sometimes you have to audition may times before you get a part.

So what type of environments should a POPOPP consider when marketing their consulting expertise?

Nursing homes, long term care facilities, assisted living communities, adult day care centers, developmental centers, even correctional facilities all have patient populations where accountable care initiatives are driven by collaborative care models and where your consulting expertise is needed.

It won’t take much. Once you’ve successfully managed a few reactive situations, the wisdom of proactive preventative healthcare is not a hard sell. 

Below is a primer on some of the collaborative care models.

Accountable Care Organizations (ACOs)
An ACO is an integrated network of providers including hospitals, outpatient clinics, primary care centers, community clinics, inpatient rehab facilities, long term care hospitals, physicians and physician groups and private practitioners like POPOPP’s (and others) that agree to be accountable for the quality, cost and overall care of those patients assigned to it. The ACO is financially rewarded with a share of the savings determined by the metrics used to measure accountable care.  ACOs were initiated under Medicare but the model is fast becoming the standard approach for health care delivery with the state- based insurance exchanges.

Bundle Payment Models (BPCI, CJR)
The Bundled Payments for Care Improvement  BPCI is four models of care with each episode of care in an acute care hospital defined distinctively for inpatient, and in some models, outpatient care which link payments for the multiple services beneficiaries receive during an episode of care with the goal of providing higher quality and more coordinated care at a lower cost to Medicare.  Models 3 and 4 are the most relevant for POPOPP’s collaborating with an acute care hospital.

It is a little bit easier to envision how a POPOPP would participate within The Comprehensive Care for Joint Replacement (CJR) model  finalized in November of 2015 and launched in April of 2016.   The most common inpatient surgeries for Medicare beneficiaries are hip and knee replacements or lower extremity joint replacements (LEJR). This model tests bundled payment and quality measurement for an episode of care associated with LEJR to encourage hospitals, physicians and post-acute care providers (read POPOPP’s) to work together to improve the quality and coordination of care from initial hospitalization through recovery.

Patient Centered Medical Homes (PCMH)
The Patient Centered Medical Home model  is an approach to provide comprehensive primary care that facilitates partnerships between individual patients and their personal providers and to promote more efficient care. Under the guidance of the Agency for Healthcare Research and Quality (AHRQ) The PCMH resource center  is focused on preventing disease and helping patients maximize health and function over the patient’s life span. AHRQ’s Prevention/Care Management Portfolio works to improve the delivery of primary care services in order to meet the needs of the American population for high quality, safe, effective and efficient clinical prevention and chronic disease care. For POPOPPs, the PCHM model seems to align more closely with the philosophy of preventative care out of all the collaborative care models.