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Tips on Alternative Payment Models (APMs)

Value-based care presents an opportunity for you to show patients, other providers, and insurance companies (public and private payers)

  1. why your services are necessary,

  2. how your services/interventions directly impact patient outcomes, and

  3. how you work together with other providers in a collaborative team environment.

Although the concept may be new, here are some tips that will help you transition to the value mindset.

On this page:

Ways to Start Thinking About Value

  • Recognize that using services creates expense rather than revenue in APMs.
  • Invest in technology and other resources (e.g., certified electronic health record technology) that help make your practice more efficient and that help improve the quality of patient care by tracking outcomes.
  • Make care delivery a team effort—everyone plays an important role!
  • Seek evidence-based resources in the Practice Portal, and provide evidence-based services to all patients. (See also: Dysphagia, Hearing Loss in Adults, Dementia)
  • Talk with colleagues and other providers with whom you have a relationship and/or any large health care systems to learn about new payment delivery models in your area.
  • See also: Medicaid Coverage of Speech-Language Pathologists and Audiologists

What You Need to Know About Value-Based Arrangements

  • Specific quality measures are used to evaluate your performance; although they vary, common measures include:
    • length of stay and/or the number of visits,
    • duration of treatment in weeks,
    • patient experience/satisfaction scores and ratings following discharge, and
    • difference between admission and discharge scores on functional outcomes data (e.g., ASHA’s National Outcomes Measurement System [NOMS]).
  • Get ahead of the curve, and gain experience. Medicare, Medicaid, and private payers are moving to a value-based reimbursement system. Track your outcomes and cost so that you can demonstrate your value in contract negotiations.
  • Value-based contracts pay providers based on factors such as, quality of care, patient outcomes, and the appropriate use of services.
  • For private practicing audiologists and speech-language pathologists (SLPs), evaluate the benefits and risks of your participation based on an assessment of your practice and market size and your true/total cost of business to evaluate whether participation in a model or contract makes financial sense for your practice.

True/total cost of business is the amount of money that you spend on providing the expected care—it consists of fixed costs (FC) and variable costs (VC).

See also: Revenue, Cost and Profit (BBC)

Advantages of Entering Into a Value-Based Arrangement

  • It opens the lines of communication with other providers (e.g., hospitals, post-acute care [PAC] providers) and payers. Consider the provider (e.g., PAC provider or hospital) or payer as a partner collaborating on ways to achieve better outcomes and care for patients because payments will be based on overall patient outcomes and experience ratings.
    • Choose a provider and/or payer with whom you have an established, positive relationship because you’re held accountable to the total patient care experience.
  • It helps you learn about opportunities to improve the care you provide. Consider choosing an area/specialty (e.g., aural rehabilitation, swallowing management, voice assessment and treatment) in which you are skilled.
  • If you’re a successfully participating private practice, you may qualify to receive a 5% incentive payment under Medicare’s advanced APMs.
  • It helps attract referrals from physicians, PAC providers, other providers, and case managers by delivering the best care and outcomes at a competitive cost, which equals value. Being part of an APM often means being connected to APM-related referral streams.

Recognizing What Diagnostic Practice Looks Like

  • Focus is on The diagnosis must be accurate using the least number of tests possible.
  • Pay attention to clinical questions.
    • Find out the reason for referral.
    • Determine the impact on function.
    • Determine the problem.
    • Recommend a solution.
  • Communicate with and keep your patients informed to ensure patient satisfaction.
    • What do they want/need to know from the diagnosis?
    • What do they want/need to do as a result of the test(s)?
  • Interdisciplinary collaboration is required. Differential diagnosis needs to consider the whole person.

Considerations for Audiology and Speech-Language Pathology Services

  • APMs may challenge clinical management skills.
  • APMs often challenge assumptions for length of stay.
  • The outcome of care must remain consistent (i.e., patients will expect to have a successful course of rehabilitation for a similar diagnosis and plan).
  • As with all patients, you must focus on quality patient care that results in superior outcomes.

Tips for Successful Participation in APMs

  • Complete your evaluations as soon as possible.
  • Focus your treatment on functional outcomes—function, function, function!
  • Individualize your treatment for each admission based on the patient’s discharge destination—even despite a short stay.
  • Engage the patient’s family and/or significant other as a care extender.
  • Find ways to promote and market the value of your services. Being a valued member of the patient’s care team will help ensure access to your services.
  • Identify areas where you add value:
    • Is the patient experiencing hearing, swallowing, or cognitive issues?
    • Is the patient able to follow directions and problem solve?
    • What other APM-identified or APM-valued health outcomes might you improve?

Questions? Email reimbursement@asha.org.

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