Developing Outpatient Therapy Payment Alternatives DOTPA

1. Developing Outpatient Therapy Payment Alternatives (DOTPA) DOTPA Data Collection Special Open Door Forum August 19, 2010

2. DOTPA Initiative Sponsored by CMS, Office of Research Development and Information Project Officer: Ann Meadow, Sc.D. Team members from: RTI Rehabilitation Institute of Chicago Boston University University of Southern California Consultants from: National Rehabilitation Hospital University of Pennsylvania FOTO

3. Purpose of this ODF Second Special Open Door Forum on DOTPA Purpose of the research Update on the data collection instruments, their origin, format and contents How providers can participate: who, when Describe data collection process and provider roles and responsibilities Describe training and other supports to participants provided by the project team Explain what�s in it for you

4. Three Main Components CMS awarded RTI a contract to help develop alternatives to the current Medicare payment cap and exceptions processes for Part B outpatient therapy services. Three main components of this study: Develop a patient assessment tool for measuring severity and outcomes of Medicare therapy patients covered by Part B Collect patient assessment data from a provider sample representing the range of settings and patients providing services under Part B Use the sample data, along with administrative data, to develop alternative payment models for outpatient therapy

5. Medicare Part B Therapists Included in Initiative: All Part B Therapy providers practicing in: Independent therapists offices CORFs/ORFs Hospital outpatient therapy departments Day rehabilitation programs Part B therapy in nursing facilities

6. Data Collection Instrument Update

7. General Principles Collect data to measure case mix and outcomes (and feasibility of using in a payment system) May be useful for care planning but focus is on patient complexity and outcomes Focus on applying case mix adjustors and outcomes measures to models based on the MFS Focus is on alternatives that can generally fit within existing system Doesn�t necessarily rule out other models�data collection will be flexible enough to support wider range of alternatives Assessment items�and therefore case mix and outcomes�should be appropriate to the ambulatory patient populations

8. Assessment Tool Approach Built on current measurement approaches used in the therapy disciplines Examined current therapy measurement systems Administrative feasibility requires a common instrument DOTPA uses skip patterns for efficient, discipline-specific items DOTPA supports a paper-based approach but electronic options will be considered at individual sites if the exact DOTPA items are used

9. Assessment Tool Approach Separate item sets for ambulatory populations and those receiving Part B covered therapy in nursing facilities or day rehabilitation programs Reflects differences in associated complications that need to be considered Items pilot-tested in several settings to consider practical issues

10. Item Development/Data Collection Process Overview

11. Stakeholder Input Items developed with significant stakeholder input Extensive input from members of the professional practice associations (APTA, AOTA, ASHA) and others Technical Expert Panel Summer 2008 to recommend items Advisory Panel contributed to refinement of TEP recommendations Recommended separate, but complementary item sets for ambulatory and more impaired populations

12. CARE-C Assessment Tool For patients in ambulatory therapy settings (HOPD, clinicians offices, CORFs/ORFs) Patient self-report section Function, participation items from the AM-PAC and PM-PAC item pools Cognitive/communication items recommended by specialists for SLP populations Estimated 5-15 minutes completion time depending on patient Clinician-reported section: Items based on FOTO and related systems approach Reason(s) for therapy, duration of problem, complications such as pain or active illnesses Screening/severity items on impairment, communication, and cognition Only completed when screening item = yes, a problem with this condition Estimated 5-10 minutes completion

13. CARE-F Assessment Tool For patients in nursing facilities and day rehabilitation programs Based on the CARE items tested in the PACPRD on populations requiring inpatient-level, nursing facility-level care, or home health services Additional communication and cognition function items recommended by the SLP community Estimate up to 35 minutes to complete depending on patient complexity

14. Key Attribute: Standardized Language CARE item sets standardize the language used to measure patient status and therapy outcomes Both tools use screening items approach to skip items not applicable to an individual patient. Easy check-off format to allow quick completion by clinicians.

15. Testing Goals Test these proposed items in different therapy settings where Part B services are provided and identify subset to consider for payment approaches. We will be looking for your feedback on these items as measures of severity and outcomes in the populations you treat under Medicare Part B.

16. Data Collection Process Provider selection and recruitment Participant roles and responsibilities Data collection support

17. Provider Selection Important for the full range of providers and patients receiving Part B covered therapy to be included in DOTPA data collection Targeting 30-50 providers in each of the following groups: Hospital outpatient departments CORFs and ORFs Clinicians in PT-only private practices Clinicians in PT and OT private practices Clinicians in any private practices providing SLP services Day rehabilitation programs Nursing facilities

18. Provider Selection (cont.) Provider selection process will also take into account: Region of the country Urban/suburban/rural location Patient population specialization More than 50 providers from a variety of settings and regions of the country have already expressed interest in participating

19. Provider Recruitment Interested providers can contact RTI: Via the project Web site (�Contact Us� page at http://optherapy.rti.org/) Via e-mail at optherapy@rti.org. By phone (Call Judith Abbate of RTI at 781-434-1793.) Recruitment timeline: Enrollment: August through November, continuing through Spring of 2011 Data Collection: Rolling start dates from September through Spring of 2011

20. Participant Roles and Responsibilities Participating providers assess new patients at start and end of Part B covered treatment Approximately 20-30 new Medicare Part B patients/month Patients chosen in a systematic, unbiased manner Up to 6 months of data collection Target: up to 150 patients/site, depending on practice size

21. Participant Roles and Responsibilities Team approach to data collection One administrative lead and one clinician lead Administrative lead ensuring that: patients are given self-report form (for providers using CARE-C); clinicians receive assessment instruments to complete; forms are collected and maintained Clinician lead for completing appropriate sections of assessment instruments Depending on your practice, more than one type of therapist may complete the items; Individualized data collection process will take into account your type of practice, range of clinicians, and administrative practices.

22. Data Collection Process Primary data collection method: paper forms RTI will provide all forms to each participating provider Each form identified with a unique serial number to guard against loss of data if forms are separated. RTI will work with providers interested in collecting and transmitting data electronically Electronic items must be exactly the items on the CARE-C or CARE-F tools. RTI will provide guidance and review for electronic submission RTI cannot provide financial support for setting up an electronic data collection system or incorporating items into an existing system but we can help you in doing so if you like.

23. Recruitment Process Recruitment/Study Process Invitations will be mailed out beginning in September and continuing through next Spring. Invitation packages will include a project overview which you may wish to share with your colleagues. For those who are definitely interested in participating, please contact us to make sure you are included in the initial sampling process � Email us at: optherapy@rti.org

24. Data Collection Support Individualized training support and logistics arrangements based on each provider�s circumstances Interactive webinar for the Site Coordinator Team and participating clinicians Individualize data collection procedures prior to the start of assessment data collection to be compatible with your current workflow practices Ongoing support throughout the process �Refresher� webinars if desired Training materials mailed and made available on the DOTPA Web site Helpdesk available via toll-free phone line, e-mail, and Web site Monthly provider check-in calls

25. Your Input is Critical! Monthly group calls will be scheduled to provide you on-going assistance and the opportunity to hear from others participating in this initiative. Your input on the individual items used with your populations will be critical 3 ways of giving us feedback: Every form asks for item comments on the last page Discussion at the monthly group calls. On optherapy.rti.org website under �contact us� � please invite your colleagues to also review and submit comment

26. Data Submission Paper versions of forms will be provided to each participating provider. Mailing materials provided to each participant Secure mailing procedure

27. Benefits of Participation Participants ensure their patients are represented: This initiative can only inform development of alternative payment systems if the full range of patients are represented Need to be sure items are tested on the full range of Medicare Part B therapy patients Participants can shape assessment measurement-related aspects of payment system alternatives through feedback Via the data collection instrument itself Via monthly calls, helpdesk inquiries, etc. Exemptions or deferrals from RAC or routine medical necessity review may be possible for participating providers during the period in which they are collecting assessment data

28. Contact Us For more information or to express interest in participating in this important, exciting CMS initiative: E-mail: optherapy@rti.org Web: http://optherapy.rti.org/