Who Pays for IPP? Coordinated care and interprofessional practice can enhance patient outcomes. Though insurers don’t reimburse for these services, changes may be on the horizon. Bottom Line
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Bottom Line  |   December 01, 2017
Who Pays for IPP?
Author Notes
  • Tim Nanof, MSW, is director of ASHA health care policy and advocacy. tnanof@asha.org
    Tim Nanof, MSW, is director of ASHA health care policy and advocacy. tnanof@asha.org×
Article Information
Practice Management / Bottom Line
Bottom Line   |   December 01, 2017
Who Pays for IPP?
The ASHA Leader, December 2017, Vol. 22, 32-33. doi:10.1044/leader.BML.22122017.32
The ASHA Leader, December 2017, Vol. 22, 32-33. doi:10.1044/leader.BML.22122017.32
Growing evidence indicates that coordinated care delivery improves patient outcomes and reduces costs and, as a result, new reimbursement models are focusing on the benefits of interprofessional practice.
Interprofessional practice (IPP) uses an informed team approach to practice. It increases the value of care for patients and payers by bringing together multiple disciplines in evaluation, care planning and treatment. But how do payers—under current and future health care models—reimburse IPP, with providers from different professions providing comprehensive services? ASHA is advocating for new, alternative payment systems—and members can support those efforts.
Traditional payment systems
Traditional payment systems do not directly reimburse for IPP—especially in health care settings—in a way that adequately reflects the time, skills and actual work needed to deliver coordinated care.
The only IPP-related form of reimbursement in traditional models is co-treatment: the provision of two different services to a patient at the same time. A speech-language pathologist, for example, may provide swallowing treatment, while an occupational therapist is helping the patient with meal preparation and adapted utensils.
However, this reimbursement for co-treatment deals only with the amount of time each professional spends providing treatment. And, under Medicare policy, co-treatment is limited to two disciplines at any given time. It does not capture the greater value of IPP, or the time and work necessary to deliver improved value through coordinated care.
What’s more, traditional co-treatment payment reduces reimbursement to the treating clinicians. For Medicare outpatient co-treatment, the time spent with the patient is divided between the two providers. In the scenario above, for example, the SLP and occupational therapist would each bill for 30 minutes, even though both spent an hour with the patient. (Inpatient coverage allows both providers to bill for the time they are actively working with the client.)
ASHA, the American Occupational Therapy Association and American Physical Therapy Association issued Joint Guidelines for Therapy Co-Treatment Under Medicare in 2012 stating that co-treatment is appropriate when coordination benefits the patient. The guidelines say co-treatment shouldn’t be used for administrative convenience or any other consideration.
They further direct clinicians to thoroughly document the reasons for and benefit of co-treatment to demonstrate the clinical value of the approach. However, even when the value to clients is clearly documented, the current payment system does not capture the enhanced value.

Recent changes to the Medicare outpatient reimbursement fee schedule, which has always been a purely fee-for-service system for based on volume, reflect payment modifications and incentives related to quality, efficiency and clinical improvement.

Alternative payment models
Clearly, the concept of reimbursement for co-treatment falls short of effectively promoting true IPP and comprehensive care coordination. The concept of alternative payment methods (APMs) can move beyond the constraints of traditional, fee-for-service and begin to incentivize IPP through payment policy. This transition can take place because increased value—translated into profit—results when the right mix of services yield the best client outcomes and the lowest cost. Providers and payers share those savings as an incentive to improved, lower-cost care.
Under APMs, especially those with shared-risk models (providers and payers share any savings or added costs), profitability is based on the value—not the volume—of services. Built into the shared risk methodology is the value of service delivery that achieves desired client outcomes.
Momentum for this concept is growing: Even recent changes to the Medicare outpatient reimbursement fee schedule, which has always been a purely fee-for-service system based on volume, reflect payment modifications and incentives related to quality, efficiency and clinical improvement.
For example, the Merit Based Incentive Payment System—the two-year-old system for setting Medicare outpatient fees, now applicable to doctors and a limited set of Medicare providers, with other providers to be added—requires providers to report quality measures, resource use details and clinical improvement activities. The Centers for Medicare and Medicaid Services use these factors to modify payment to providers, and reporting them is clearly related to demonstrating value that can be increased through effective IPP.
Given APMs’ emphasis on value over volume, audiologists and SLPs can demonstrate their value through IPP and care coordination. IPP can enhance value across clinical settings and throughout the continuum of care, from evaluation and care planning, through treatment and discharge. IPP is indirectly reimbursed under APMs: IPP improves patient outcomes, reduces lengths of stay and decreases readmissions, which ultimately result in improved bottom lines for providers and payers.

The concept of alternative payment methods can move beyond the constraints of traditional, fee-for-service and begin to incentivize IPP through payment policy.

Coding
Will there ever be Current Procedure Terminology (CPT, © American Medical Association) codes for care coordination and IPP? CPT—used by health care providers to describe on billing forms what treatments and procedures they provided to a patient—includes care coordination codes, but only for physicians who lead care coordination activities for patients with chronic and complex conditions.
Companion codes for other professionals on the team have not been developed or approved, but ASHA staff and members of the Health Care Economics Committee are leading efforts to do so. The most recent American Medical Association code development and valuation meetings included discussion of the development of care coordination codes for non-physician, but no timetable is in place for final action. ASHA also has named an Ad Hoc Committee on APMs to oversee ASHA member education on participating in and advocating for APMs.
Engage
The best way to prepare for these significant reforms is to stay informed:
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FROM THIS ISSUE
December 2017
Volume 22, Issue 12