Abstract
The exploration of literature on ACOs, an alternative payment model run by the Centers for Medicare and Medicaid Services (CMS), indicates important opportunities for impact for OT practitioners. It is vital that OT practitioners promote value over volume and advocate for inclusion in new payment models, or they risk reduced funding and support from CMS and other payers. ACOs present a unique opportunity to grow the profession.
Primary Author and Speaker: Clarice Miller
This paper identifies the role and opportunities for the occupational therapy profession in Accountable Care Organizations (ACOs) and value-based care. Accountable Care Organizations are a popular alternative payment model promoted by The Centers for Medicare & Medicaid Services (CMS) focused on care coordination and primary care. The ACO model promotes value over volume and capitated payments. As these models increase in popularity, more practitioners will find themselves working for ACOs or treating beneficiaries enrolled in an ACO.
The research design is a descriptive literature review of materials produced by the Centers for Medicare and Medicaid Services (CMS), Health Affairs Journal and Blog, AOTA, and other researcher firms in addition to qualitative interviews with industry experts. Data was collected in an exploratory manner to identify possible correlations between the goals of ACOs and areas of practice of occupational therapy. The findings indicate multiple opportunities for occupational therapy practitioners to positively contribute to the goals of ACOs and value-based care through evidence-based practice, appropriate documentation and billing, successful discharge planning, and the promotion of occupational therapy in primary care settings.
In conclusion, occupational therapy practitioners must provide evidence-based and client-centered care to facilitate the integration of therapy services into the ACO Model and future alternative payment models. Proving the value and cost-effectiveness of occupational therapy services is vital to preserve the profession as insurance companies and the federal government eagerly search opportunities to reduce spending and eliminate unsubstantiated services. Inclusion in alternative payment models, such as ACOs, will cement our role in the future of healthcare in the US. Ongoing debates about the future of the healthcare delivery system provide a unique opportunity to promote change and grow the influence of occupational therapy.
This research directly impacts the Effective, Leaders, and Collaborative pillars of the AOTA 2025 Vision. The findings promote evidence-based and cost-effective therapy, advocating for occupational therapy practitioners to influence policies, complex systems, including electronic medical records, and collaboration with clients and care providers to produce the most effective outcome. All of these components are additionally supported by Accountable Care Organizations making it a natural fit for occupational therapy practitioners to expand their influence.
Centers for Medicare & Medicaid Services. (2017). Accountable Care Organizations (ACO). Retrieved November 2017, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Medicare Learning Network, Centers for Medicare & Medicaid Services. (2014). Summary of final rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program. Baltimore, MD. Retrieved from https://kaiserhealthnews.files.wordpress.com/2014/04/aco_summary_factsheet_icn907404.pdf
The American Occupational Therapy Association. (2012). Accountable Care Organizations and Medical Homes. Bethesda, MD. Retrieved from https://www.aota.org/∼/media/Corporate/Files/Advocacy/Health-Care-Reform/Ad-Hoc/ACOs%20%20Medical%20Homes%20Fact%20Sheet%202012%20combined%20%20rev%2022012.pdf
Muhlestein, D., Saunders, R., & McClellan, M. (2017). Growth of ACOs and Alternative Payment Models in 2017. Health Affairs Blog. Retrieved November 2017, from http://www.healthaffairs.org/do/10.1377/hblog20170628.060719/full/