PTPN, Calabasas, Calif, a network of rehabilitation professionals in private practice, reports that its “Pay for Outcomes” program has been adopted by Cigna, Health Net and Aetna. PTPN explains that the program is designed to recognize and reward providers who meet the highest standards in patient outcomes. PTPN also notes that the agreements apply only to PTPN rehab therapists in California.

In a recent PTPN news release, the organization explains that the incentive plan is based on the PTPN Rehab Outcomes Index (ROI). The PTPN ROI is reportedly intended as a comprehensive quality report card for outpatient physical therapists (PTs) and occupational therapists (OTs). The organization adds that providers who earn the incentive are paid on fee schedules that range from 5% to 12.5% higher than those typically seen in fee schedules.

Michael Weinper, PT, DPT, MPH, PTPN president, states that the organization has seen a trend in the health care industry in which “pay-for-outcomes,” is replacing “pay-for-performance.”

“Medicare and private payers are increasingly linking reimbursement to patient outcomes as an incentive for providers to improve quality of care. Health care reform and regulatory provisions are also calling for providers to be accountable and transparent about outcomes and other quality measures,” Weinper says.

Weinper adds that PTPN anticipated these changes prior and as result, it began to measure outcomes for its therapy offices 5 years ago. “As an outgrowth of the PTPN Outcomes Program, we developed the PTPN ROI to assess our therapist’s outcomes data and spotlight providers who deliver the most value—those that achieve the best patient outcomes most cost-effectively,” Weinper reports.

PTPN is also pursuing similar agreements with other payers and other regions, according to the release.

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Source: PTPN