the physical therapy mso model: get big . . . but stay … and billing training 18 practice...
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The Physical Therapy MSO Model:
Get Big . . . But Stay Small
Owner Goals
Market Demands VALUE
10 BIG HCR CHANGES IMPACTING PHYSICAL THERAPISTS
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Triple Aim Risk Sharing
Payments
Patient Centeredness
Collaboration Consolidation
Innovation
Greater Regulations
ACOs
Downward Pressure on Payments
Patient Centeredness
All are Related to Size and Value
CONSOLIDATION
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When two or more organizations come together under to form a
larger business entity with common leadership, direction – vision,
mission, strategy, goals - under a single Tax ID Number.
Networks are not considered a consolidated or integrated business
Hospital A Hospital B
2 GI Practices
3 Orthopedic Practices
4 PT Practices
7 Primary Care
Practices
Independent Health Care
Market 4
PT MSO with more Independent Practices
Huge GI Practice
2 Very Large Ortho Practices
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5 REASONS PROVIDER PRACTICES CONSOLIDATE AND GROW
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1. First and Foremost . . . Negotiating Strength
2. Better Able to Share Financial Risk with Health Plans
3. Manage Regulatory Compliance and Business Mgmt Expectations
4. Access to Capital for Growth
5. Bottom Line Value Growth
THERAPY PRACTICE OPTIONS
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“If your business does not grow . . . It dies.”
Joe White, CPA, Health Care Business Consultant
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4 Organizations Deliver the Vast Majority of OP PT
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Care Systems Corporate
PT POPTS
Independent Practices
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PT is Job 1
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Care Systems ✔
Corporate PT
POPTS ✔
Independent Practices
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Controlled and Financed by Local Physical Therapists
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Care Systems Corporate
PT POPTS
✔ Independent
Practices
THERAPY PRACTICE OPTIONS
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Stay the Course
• Go it alone. • Small is better • Depend on
Relationships • Cash or Out of
Network
1 Big, Independent.
• MSO - Own Your Practice
• Team with Others • Under Single TIN • Scale Economies • Strength of Size • Value Models
4 Grow My Own
• Open new clinics • Grow existing
clinics • Buy other
practices • Merge
2 Time To Sell
• Consider the various corp PTs
• Culture Fit? • Sell 100%? • Joint Venture? • Sell 51-90%?
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To Deliver Size and PT Value Models
THE MSO MODEL
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Who Wants to Be Part of an MSO?
1. Contract with health plans and ACOs
2. Want to gain strength of size - part of something bigger
3. Like being a team player
4. Want to maintain ownership of practice
5. Culture is important to owner and employees
WHY MSO?
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Our 6 Point Mantra
1. Best Decisions Made Close to the Patient – Therapist
2. The Farther Away … It’s All About Money
3. Independent Practices Best Aligned to Build Relationships, Deliver Value
4. You Must Be Big to Have an Influence
5. We Must Have Trusted Relationship with Decision Makers
6. We Must Deliver Value … Set Expectations … Provide Accountability
THERAPY PARTNERS MSO VIEW OF WORLD
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A business model that integrates independent practices as a consolidated team under a
single tax ID number for the purposes of contracting with health plans and other payors
while the practices maintain their brand identity and their own TIN for tax and other
legal purposes. The MSO provides centralized administrative services including revenue
cycle management, payment processing, and other tactical activities.
The MSO brings value to payors by simplifying processes, creating stable access,
delivering predictable outcomes, and providing a willingness to share financial risk.
The MSO brings value to members through better payment, reduced operational costs,
and an ability to focus on strategically growing their businesses.
MANAGEMENT SERVICES ORGANIZATION - MSO
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5 Keys to Success of an MSO:
1. Trust
Practice owners must trust each other and the MSO leadership and team
2. Leadership
Strong Leaders with a Shared Vision of the MSO and Members for Success Together
3. Teamwork
All Owners See Each Other as Business Partners and Allies . . . NOT Competitors
4. Accountability
All Practice Owners and Their Teams Contribute and Perform as Expected
5. Accuracy
RCM, payment processing must have defined, disciplined workflows; daily accuracy
MSO SUCCESS
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PAYOR AND ACO RELATIONS
▶ Health Plan and ACO negotiating and contracting under MSO TIN
▶ Health plan negotiations
▶ Value Based contracts – risk sharing
▶ Credentialing
▶ Resource for PT outcomes / care management Services
▶ Centralized Billing Office
▶ Billing / EMR Technology
▶ Billing and A/R Management
▶ Payment Processing
▶ Coding and Billing Training
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PRACTICE MANAGEMENT
▶ Compliance
▶ PTManager Application
• Financial, Performance, Project Management
▶ Marketing
▶ Clinic Support Training SERVICES
▶ FOTO Training and Outcomes Management
▶ Clinical Management
▶ Leadership and Team Development
▶ Clinical Learning Programs
▶ OCS / SCS, other Specialty Prep and Support
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OUTCOME MANAGEMENT
FOTO ▶ FOTO in Value-Based Contracts
▶ FOTO Training and Outcomes Management
▶ Clinical Management
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POSSIBLE SERVICES
▶ Marketing
▶ HR Management
▶ Financial Management – CFO
▶ Health Insurance and Other Benefits
▶ Payroll
▶ 401K
▶ Access to Capital
▶ Group Purchasing
Other Services
MSO BRINGS VALUE TO
HEALTH PLANS & ACOs
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COMPLEXITY
Health Plan or ACO
Contracting &
Credentialing
Process Claims from
Practices
Make Payments to
Practices
Practice
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Practice 4
Practice
1
Practice 2
Practice 8
Practice 7
Practice 6
Practice 5
Practice 7
Practice 5
Practice
3
Practice
1
Practice 8
Practice 6
Practice 4
Practice 2
MSO Organize Under a
Single TIN
One Source Contracting, Risk Sharing, Credentialing, and Care
Management
Billing Department Billing and
A/R Management
Payment Processing, Posting and Distribution to
Practices
Health Plan or ACO
Contracting with Risk Sharing
Arrangements
Process Claims from
Big Provider Group
Make Payments to
Big Group
SIMPLICITY – REDUCES THEIR COSTS
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Health Plan or ACO Invests to
Control Cost
UM
for Cost Control Ave Visits – 12.0
Range – 8.5 to 18.5
Care Management for Quality
No Consistent Quality Measures
Practice
3 Ave Visits – 10.0
Outcomes - ?
Practice 4
Ave Visits – 18.5 Outcomes ?
Practice 2
Ave Visits – 14.1 Outcomes – ?
Practice 8
Ave Visits – 8.5 Outcomes ?
Practice 7
Ave Visits - 17.0 Outcomes ?
Practice 6
Average Visits - 9.8 Outcomes ?
Practice 5
Average Visits – 13.0 Outcomes ?
INCONSISTENCY
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Practice
1 Ave Visits – 12.5
Outcomes ?
Health Plan or ACO
No Financial or Human
Resources Devoted to Care
or Utilization Management
Saves $$$$
MSO Measures Outcomes
Efficiency (Ave Visits or Cost)
8.5 visits Predictable Cost
Effectiveness (Functional Improvement)
85th Percentile Predictable Functional Change
Value (Improvement per Visit)
90th Percentile
1 9.5 – 85th
Visit & Function
Outcomes Data
2 8.5 – 80th
3 7.5 – 85th
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9.0 – 90th
5 8.0 - 90th
FOTO – 78% 6
8.6 – 90th
7 8.4 – 81st
8 8.2 – 85th
Visit &
Functional Outcome
Data
PREDICTABILITY – LOWER COST, BETTER HEALTH
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MSO BRINGS VALUE TO
PRACTICE OWNERS, YOUR TEAMS, AND YOUR PATIENTS
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Administrative and contracting entity that
▶ Tightly Integrates independent practices
▶ Allows practice owners to own, control of their business
▶ Through single TIN, creates efficiencies in operations
▶ Creates strength to negotiate, build relationships with payors
▶ Provides billing, technology, admin, and care management
MSO
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Defined business entity that
▶ Allows practices to reduce costs
▶ Brings negotiating strength for better contracts
▶ Through outcomes management, allows value based models
▶ Provides owners practice management tools
▶ Offers clinics professional development programs
MSO
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▶ Allows practice owners to focus on
• Improving care and clinical skills
• Building relationships in their community
• Growing and managing their practice
• Maintaining your culture
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THERAPY PARTNERS MSO
▶ We believe in the power of independent practices.
▶ We are transforming the value of physical therapy in the market and how our practices are rewarded for delivering that value
Why
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THERAPY PARTNERS
▶ Grow MSO in US as Alternative to Selling to Corporations
Strength of Size
Long Term Ownership and
Financial Success
Vision
Mission
▶ Reduce Operational Expenses of Members
▶ Improve Reimbursement
▶ Manage Financial Risk Sharing
▶ Provide Practice Management Support
▶ Deliver Triple Aim Value
▶ Grow Practices – Increase New Patients, CRM
$$$$
$$$$$$$
$$$$$$$$$$$
Office Visits – LOW COST Physical Therapy, Chiro, Primary Care
Imaging – HIGH COST; Leads to HIGHER COST
Injections – LOWER COST but Leads to HIGHEST COST
Surgery – HIGHEST COST
$$
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TPI BASIC VALUE PROPOSITION
SOLUTION
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Reality of Power
Decision Makers
Strategy
Innovation Mission
Triple Aim Culture
Value
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HEALTHPARTNERS PLAN . . . 1.3M MEMBERS
▶ Value-Based Model Since 2010
▶ Use FOTO with Quality / Value Benchmarks
▶ Per Diem Rate with Bonus
▶ Per Diem Rate 50% Higher than Standard
▶ Achieved 84-100% of Bonus Each Year
▶ TPI is a Resource – Strong Relationship w Plan
Value Model
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THE TPI TEAM
▶ Everyone must be on same billing system - BMS
• Efficiencies and Transparency
▶ Use 1 of 2 EMRs with BMS - RevFlow or WebPT
▶ All contracts under name and TIN of MSO
▶ Reduce your staff – the people factor
▶ Give up about 20% of decision-making – 80/20
▶ Team play / Allies concept very hard for some
The Challenges
30-40%
Go with the Flow But Take Time to
Embrace
Strugglers
HOW PEOPLE RESPOND TO CHANGE
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15-20%
Hate It! Resist It!
Resistors
5-10%
Hate It! Resist It!
Try to Make It Fail!
Fighters
15-20%
Embrace Change Convert Resistors
Supporters
5-10%
Love it!
Champions
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THE TPI TEAM
▶ Build Own MSO with TPI Services. TPI has infrastructure and expertise. TPI does RCM, payment processing, outcomes and care management, helps with health plan contacting. CPTN hires Exec Director; engages a contracting rep to work with TPI (boots on the ground). Pays base % of collected net revenue. Credentialing, compliance, marketing, etc either done in Colorado or via TPI – optional. Start up fees + ongoing % revenue. Cheapest & easiest.
▶ Build Own MSO with TPI as Consultant. TPI provides CPTN with processes and information to start own MSO (eg workflows, policy & procedures, staffing metrics, on boarding processes, etc). CPTN hires Exec Director; engages a contracting rep; either outsources RCM to BMS or uses BMS technology and hires own billing staff; hires payment processing staff and staff to perform all duties of MSO. Expensive, complicated, steep learning curve; Ownership challenges. Higher start fee + consulting fee per need
▶ Build Own MSO. Build it and staff it from scratch. Expensive, very complicated, very steep learning curve; ownership challenges.
MSO Options for CPTN
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TPI PROPOSAL TO CPTN – 2 LEVELS OF SERVICE
Getting Started • MSO Business Plan • Work flows • Organizational Design • Job Descriptions • Compliance Training • Committee Structure and Makeup • Owner Leadership and Change Management • Steering Committee Participation
Start Up - $25,000 – 3 installments over 4-6 months
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Ongoing • Payment processing, reconciliation, distribution to practices
• Compliance – HIPAA, PHI, Audits
• Payor Contracting – Consulting/Design (working with your ‘boots on the ground’ leader - Mark). This will include trips to Colorado as needed.
• Charge Audit
Fee - Either a percentage of revenue (on top of BMS) or a $/per visit. We will need more accurate data on revenue and visits from each practice
TPI PROPOSAL TO CPTN – 2 LEVELS OF SERVICE
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Ongoing - Additional • FOTO Training and Outcomes Management – to ensure you optimize your
results
• Leadership Edge Program for All Practice Owners and Leadership –critical for your long term success.
• PTManager Practice Management Software – Monthly Productivity Reports, Annual Expense/Productivity Analysis, Performance Management, Change Management
Fee – One time or annual fee
TPI PROPOSAL TO CPTN – 2 LEVELS OF SERVICE
If the rate of change on the outside exceeds the rate of change on the inside … the end is in sight.”
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Jack Welch, Former CEO, GE