Keeping Pace with Change

By Bridget Morehouse, MPT, MBA

Change continues to dominate the payment landscape for Private Practice Section (PPS) members and health care providers across the spectrum. The challenge of keeping pace with change and innovating clinic operations can be daunting at times. The Payment Policy Committee works diligently to be aware of payer and market changes as well as to develop and deliver practical resources for PPS members.

After spending the past two years focused on implementing resources, and delivering pricing information from the data set purchased from Milliman, the committee is slightly shifting gears to stay ahead of additional changes within the industry. Specifically, these include value-based contracting, the Comprehensive Care for Joint Replacement (CJR) pilot from Centers for Medicare & Medicaid Services (CMS), and industry consolidation driving vertical partnerships. The committee has formed work groups with specific objectives to address these areas. In addition, the PPS Board of Directors has committed monetary support to engage additional outside legal expertise to support the CJR and the value-based and payer contracts work groups. The committee has already put out one webinar this year on CJR and has one or two additional webinars planned. The committee will continue to share expertise through articles in Impact and the weekly e-newsletter. The objectives for these work groups are listed here.

Value-Based Model and Physical Therapy Contract

• Develop a model participating provider contract for private practices that would be held with a third-party payer; the contract should include common clauses found in a participating provider contract.
• Manage request for proposal (RFP) process for soliciting outside legal resources.
• Design a webinar that will be recorded and maintained on the PPS website for members.
• Draft two or three articles for Impact magazine highlighting the key aspects and strategies when negotiating with payers.

CJR

• Provide template CJR Collaboration Agreement for members.
• Manage RFP process for soliciting outside legal resources.
• Provide education and updates to members on CJR through Impact magazine.
• Design updates to members at the pre-conference session regarding CJR.
• Address member questions regarding CJR.

Vertical Integration and Joint Venture Partnerships

• Explore potential vertical integration/joint venture opportunities for PPS members.
• Provide case studies of successful partnerships.
• Educate members on potential partnership opportunities through Impact magazine, webinars, or in the pre-conference.

Finally, the committee is planning to provide a 4-hour Pre-Conference Payer Update session at the PPS annual conference. This will be provided to members who register ahead of time. This is the third year of offering this session. Previous years’ sessions were limited to standing room only. The topics will include Medicare updates, including CJR, and major payer updates. We look forward to seeing you there. It is a priceless member benefit that is sure to provide you a return on investment. The committee thanks Allyson for her endless energy and attention to detail and is tremendously grateful for the Board of Directors’ support, which always proves to be without limits.