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ATI Physical Therapy: Payment Models for Healthcare to Gain Foothold in 2016

Patient Choice and Transparency Among Other Key Healthcare Trends

As the healthcare field continues to evolve and providers maneuver the new landscape that the Affordable Care Act has created, several key trends will gain stronger traction in 2016, according to the ATI Physical Therapy Department of Research and Data Analytics. ATI is a nationally recognized healthcare company, specializing in outpatient rehabilitation and adjacent healthcare services.

The new focus on care coordination and management will facilitate a bigger move to “Value-based Care” for many patients and healthcare organizations in 2016.  At the center of value-based care, which focuses on patient outcomes versus the number of patients treated, is the move to a bundled payment model. A bundled payment model typically encompasses an average total cost of a procedure which would include pre-operative services, surgical services and post-surgical services including physical therapy in most orthopedic instances. The total cost is then allocated to each provider that treats the individual during the patient life-cycle or bundled period. The bundled payment model is typically used when two or more services are rendered. 

“For the bundle payment model to be an effective method of treatment and to provide value for the patient and the healthcare provider, effective care coordination and management is key,” said Chris Stout, Ph.D., vice president, Department of Research and Data Analytics for ATI. “We are just starting to see the strong benefits and value of having a person or organization coordinate a holistic view – from end-to-end – of a patient’s care. This oversight allows effective and timely communication to all parties, providing real-time clarity on where, for example, certain services might not be required or where other services might need to added. This allows for a tailored approach for the patient, while creating value for the healthcare organization.”

According to recent studies, Medicare bundled payments have created an average savings per orthopedic case of about $4,000.  Sixty-seven markets, including New York City and San Francisco, have resulted in an estimated $343 million in savings to Medicare. An additional eight more markets were required to launch bundled payments as of January 1, 2016.  

Along with care coordination and management, patients will continue to remain in the driver’s seat when it comes to their healthcare decisions. With consumers paying more out-of-pocket healthcare costs, online and referral research for value and convenience will accelerate. This, in turn, means that many healthcare organizations will have to begin or ramp up both marketing and social media spend to increase click-through rates, ultimately resulting in patients and referrals.  

Transparency at every stage of the patient’s lifecycle will also expand in 2016. While many healthcare organizations have realized that transparency in their billing practices is a key driver for high marks in satisfaction surveys, many patients still remain in the dark about the actual cost of services. Many states, like Massachusetts, have passed legislation to provide consumer timely and clear information about the prices of healthcare provided services. 

“While some progress has been made in transparency, the healthcare industry, in general, can do a much better job in this area,” continued Stout. “We should expect to see patients demanding to see additional transparency beyond billing in 2016, possibly moving into the areas of testing, survey results from a provider, and outcome results and testimonials. Millions of more savvy consumers now have healthcare insurance under the Affordable Care Act and will help lead the charge in transparency and price comparisons. If done correctly, progressive healthcare providers, along with consumers, will reap the benefits.”