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Written by: Darlene D'Altorio-Jones (1959-2015) on Tuesday, August 30, 2011 Posted in: Outpatient Rehab

The Centers for Medicare and Medicaid Services established the “Developing Outpatient Therapy Payment Alternative” (DOTPA) research project to identify, collect and analyze therapy-related information tied to beneficiary need and the effectiveness of outpatient therapy services. CMS awarded the DOTPA initiative as a contract to RTI International in January 2008. If you have a high volume of Medicare outpatients, you will want to keep a keen eye on research presently underway. Nearly 200 facilities will participate in data collection for this project awarded to RTI International. The RTI International website has been established to educate and inform outpatient therapy providers of the progress of this work.

DOTPA was authorized by section 545 of the Benefits Improvement and Protection Act (BIPA) of 2000. This rule requires the Secretary of the Department of Health and Human Services to report on the development of standardized assessment instruments that could be used as alternatives for post acute care services, including outpatient therapy practices as we know them today.

Section 545: Development of Patient Assessment Instruments.

This position requires the Secretary to submit to Congress a report on the development of standard instruments for the assessment of the health and functional status of patients who are furnished the following services: inpatient and outpatient hospital services; inpatient and outpatient rehabilitation services; covered SNF services; home health services; physical or occupational therapy or speech-language pathology services; items or services furnished to beneficiaries with ESRD; partial hospitalization services and other mental health services; and any other service for which payment is made that the Secretary deems appropriate.

This, along with continued developments from the 2005 Deficit Reduction Act, will shape the future of healthcare practice. There is no escape; become familiar with how guidance will be developed, specifically for outpatient services.

Short term alternatives such as placing a CAP on utilization to a dollar amount was largely contested as an ineffective way to managing payment guidelines. Despite guidelines on standard content required for evaluation, certification and progress summary; very little has been done to aggregate meaningful information on the dollars spent in treatment rendered by therapy practice including the overall value for those dollars spent. Where are we most successful and is treatment effective in meeting the goals established to reduce the impairments presented for outpatient care?

RTI recently stated on their website, ”Presently, CMS cannot adequately assess the appropriateness of utilization patterns or the impact of changes in payment policy without access to better information tied to patient need and the effectiveness of the outpatient services provided.” RTI has established assessments that will include both patient and self-reported items. If patients are unable to complete items, a proxy can provide the required information. According to the website, RTI is recruiting providers to participate from various types of settings that provide therapy services covered under the Medicare Part B Medicare Benefit.

These include:

– Hospital outpatient departments
– Nursing facilities (NFs)/Skilled nursing facilities (SNFs)
– Comprehensive outpatient rehabilitation facilities (CORFs)
– Outpatient rehabilitation facilities (ORFs)
– Private practices (PT, OT and SLP)

Barabara Gage of RTI recently spoke at the Mediware Annual Conference. She shared information on opportunities for engagement at various levels of studies RTI is conducting and specifically addressed the need for 190 participants for Part B covered services studies.

RTI proposes the following breakdown for participation: 29 hospital OP departments,  29 ORF/CORF departments, 29 private practices, 29 PT/OT practices, 29 SLP practices, 45 skilled or assisted living part B providers.

RTI will develop a set of alternative payment models that could refine or replace the current method of paying per claim subject to discipline-specific caps or those not affected by caps, such as hospital based providers. The project team will analyze the measures collected via the assessment instrument merged with claims data and provide recommendations based on the results and analyses. This process will also include assessing the feasibility of incorporating pay-for-performance aspects into payment for these services.

Development of alternative payment models may focus on case-mix classification, bundling, patient-level payment limits and pay-for-performance. It is important to note that these approaches are not independent, and alternative models could include elements of each.

Stay engaged on the progress of DOTPA by creating a link to the RTI website.

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