Ambulatory Care: A key concept for Collaborative Care Models within Health Care Reform
The very term “Ambulatory Care” underscores the importance of professional foot care in the healthcare continuum. Perhaps one of the most critical initial patient assessments is that which determines the patient’s ability to ambulate. If a patient is mobile then the ability to benefit from the care from the other collaborators in the patient’s healthcare team is undoubtedly improved.
It follows that it is logical that the importance of the role of Podiatrists, Orthotists, Prosthetists Occupational therapists, Physical therapists and Pedorthists, (whom I will collectively acronym as POPOPP’s ) as allied healthcare professionals within a collaborative care model cannot be overstated.
The Patient Protection and Affordable Care Act of 2010 (ACA) is designed to change the way healthcare is delivered and reimbursed. Collaborative care models under the ACA reform are designed to transform the health care system to improve quality, affordability and experience of care.
To better understand how a POPOPP might function as a member of the inter-professional care team for patients across their lifespan, I’ve briefly outlined the different collaborative care models below.
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 in which each episode of care in an acute care hospital is defined distinctively for inpatient, and in some models, outpatient care that 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.