Payment for Outcomes Flashcards
Outcome
Degree of health or recovery
What is the gold standard in relation to PT outcomes?
Functional status
What other categories are in PT outcomes?
Pain level
Ability to return to physical activities
Ability to return to work
Value=
outcome/total cost
Pay for reporting
portion of data must be reported or payment is at risk
Pay for performance
part of payment is tied to performance
IMPACT ACT of 2014
SNFs, IRFs, and LTCHs must begin reporting on quality measures
Data set ffrom Impact must include:
Functional status and changes in function
Skin integrity and changes in skin integrity
Medication reconciliation
Incidence of major falls
Patient preferences
IMPACT ACT GOAL
To advance PAC (post-acute care) reform
Payment should be based on patient needs, not site of service
What did Post Acute Care sites (PACs) have to report on:
Medicare Spending Per Beneficiary (MSPB)
Discharge to community
Hospitalization rates of potentially preventable readmissions
Global Function
Measures that quantify patient’s overall functional status
Includes mobility, ADLs, etc. (e.g., OPTIMAL, AMPAC, PROMIS, SF-36
Condition/Body Region Specific
Measures that quantify functional status for a specific condition or body region
Activities for a condition or body region (e.g., Neck Disability Index, Oswestry, DASH, etc.)
Performance Based
Measures that quantify function specific to a task or tasks
Specific activities patient is asked to perform (e.g., Tinetti, TUG, 6-Minute Walk Test, etc.)
Quality assessment
refers to measurement of quality compared to some goal or standard
Quality assurance
continuous quality improvement
5 things that most affect customer satisfaction
Communication of treatment plan from patient’s perspective
Consistency of clinicians
Respect for patient autonomy & patient input
Time clinician spends with patient
Clinician understands patient’s history & condition
4 steps of CQI:
Measure performance: where are we now?
Set goal for future performance: where do we want to be?
Implement process changes: how do we get there from here?
Measure: were we successful in getting there?
Comparative effectiveness research
Comparison of one form of treatment versus another
Who does G codes apply to?
All practice settings that provide outpatient PT, OT, and SLP services for Medicare Part B beneficiaries
Functional limitation categories
Mobility Changing and maintaining body position Carrying, moving and handling objects Self care Other
