After 15 years of no significant change, the Centers for Medicare and Medicaid Services (CMS) has released bold new strategic guidance for the Centers for Medicare and Medicaid Innovation (CMMI). About three clear pillars (evidence-based prevention, empowerment, and expanded provider choices) construct this transition, which marks a new era of value-based care (VBC).
It has a great impact on rehabilitation therapy providers, including physical therapists (PTS), occupational therapists (OTS), and speech pathologists (SLP). The work of rehabilitation professionals has long been consistent with prevention and functional outcomes. Now, the CMS explicitly calls on these priorities to lead the next phase of healthcare innovation.
So the question is not “Can rehabilitation therapy fit this model?” The question is: “Will we rise up and prove this?”
Preventive Policy: Openness of Active Rehabilitation
The renewed focus of CMS on prevention is not just about validation by rehabilitation professionals. Making our value is undoubtedly a challenge. Therapists are already on the frontlines of fall prevention, mobility recovery, chronic condition management, and speech and swallowing improvement. These are services that reduce downstream costs and improve quality of life. However, historically, it has not always been captured in the result data CM and the result data that the payer relies on.
Now, this is changing. CMS expresses commitment to early intervention in all care settings and plans to redesign existing models to reflect this priority. The first of its three new pillars reads: “Promote evidence-based prevention.” For many in the rehabilitation field, this is a call for action.
Results, results, results
While prevention may be the title, the subtext in the new CMS launch is clear: the result will be a currency of credibility. Whether through formal indicators, progress in patient reporting or based on the results of the claim, rehabilitation providers must demonstrate the large-scale impact of their care.
Capturing and communicating results is not a new idea, but it is still difficult for many people in the field to do this effectively. This gap may become a responsibility as CM and the broader health system shifts its focus more actively to value and accountability.
Recently, CMS consistent webinar mentioned the importance of outcomes in the first hour more than 40 times. The news is clear: If your organization isn’t ready to quantify value, it may be thrown away soon.
This moment invites rehabilitation therapy to go beyond anecdotal success and more clearly align with the evolving framework for compensation and care delivery. Good news? Therapists already possess the trust, access and real-world results of patients. What is needed now is the infrastructure and prove its intention.
A more open competitive environment for independent providers
In another notable shift, the new CMS strategy emphasizes support for independent providers, not just large health systems. This can be a game-changer for rehabilitation professionals in outpatient clinics, rural practices, or small community settings.
CMS clearly states that the Innovation Center model will aim to “a competitive environment for providers who practice independently”. This includes achieving an upfront investment in patient care, which is often difficult to obtain in smaller practices.
The program may create new opportunities for therapeutic practices to engage in value-based arrangements and pilot models without the need to absorb large hospital systems. This also promptly reminds you that scale is not the only way to influence – outer holes and alignment are more important.
What’s next?
The vision of CMS is ambitious, but the potential of rehabilitation therapy is also the potential to shape its execution. To this end, providers must actively participate, document their impact, and advocate for the inclusion of it in an evolving model of care.
This article is a broader exploration of what value-based care means for rehabilitation therapy and what needs to meet the needs of the moment. Over the next few months, I will look deeper into strategies to capture results, optimize care pathways and prepare for the next wave of CMS-led transformation.
Photo: Kutubq, Getty Images
Susan Lofton is a physical therapist with 25 years of experience in clinical care, operations and advanced management. Susan has worked in a variety of healthcare facilities including acute, IRF, skilled care, family health and outpatient clinics, giving her great understanding of the patient’s transitional needs and the internal functioning of the healthcare ecosystem. Susan is passionate about improving healthcare and has deep expertise in regulatory compliance and optimizing successful strategies. Susan is Vice President of WebPT, Outcome and Clinical Transformation and is involved in MIPS and other quality payment programs by Keet Results Qualified Clinical Data Registration (QCDR).
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