Alex (00:00) Once somebody sees PT as PCP for musculoskeletal needs and you are the first point of encounter versus anyone else in the medical model, that's where you see that the true innovation that someone is less likely to pursue other medical services for the same problem when PT is the first point of contact.

Good morning friends and colleagues and welcome to the seventh episode of Future Thinking PT. It is great to be here and I want to welcome my co-host and my dear friend Dana Strauss. And today we're going to discuss a couple of really interesting things. The first thing Dana is going to discuss is the TEAM model that is emerging. So all the intricacies of this really innovative, interesting model that will become much more prevalent in the next 12 months.

And then we're going to go a little bit deeper into the weeds of PT as PCP using a military model. So both the validation, the safety profile, and some of the references that are being present. So without any further ado, Dana, I will hand the microphone off to you and you can run us through this really cool model that is emerging.

Dana Strauss (01:08) Great, thank you, love to be back, episode seven, woohoo! Making progress every week.

So for anybody who's not familiar with the TEAM model, the transforming episode accountability model, it is about acute episodes of care and it is based on the original and the subsequent bundle payment for care improvement and the advanced model as well as the comprehensive care for joint replacement model.

Both of those models, these are Medicare Fee for Service models, were based on 90 day episodes of care after the hospital. So your discharge from the hospital is day one, it goes all the way to day 90.

And essentially what the model says is everyone is going to bill normally for patient care starting when they're in the hospital, the hospital bills normally. Everyone who has any interaction with that patient and bills Medicare is going to bill normally. Nothing changes about how they're reimbursed across those 90 days. But then

When Medicare looks back every six months, they look back at the episodes of care during that time period, they reconcile the difference between how each individual patient did during that time. They look at their quality metrics, they look at their utilization, they look at their total spend, and they compare

to benchmarked cost and quality factors. they'll have what they call the target price Whoever is the participant in the model, in some cases, it was the hospital, in some cases, it was the specific physician,

that individual would either

earn additional dollars because the spending was less or would have to pay back CMS additional dollars because that individual spent more than was expected. And so if you can kind of imagine some of the things that would make someone cost more than expected, that would be things like higher than expected utilization of post-acute care, readmissions

If you manage care better than was done historically by being very careful about where you're selecting and working with the patient and the family on where they go after the hospital, when you keep patients mobilized when they're admitted to the hospital, when you help with the transitions of care to make sure they're all happening safely and there's a lot of opportunity to do better here, all of those things can help you do better in many cases. So if you can have two thirds of cases, for example, do better

than historical, better than expected you're going to end up making money in the program. In the TEAM model they took all these lessons they've been learning through these episodic models and they start it off now with a mandatory surgical episodes of care model with five different diagnostic groups and for those patients are going to be hospital being at risk for the episode and then look

at the spend and outcomes for 30 days after. And what Medicare had said our plan is to turn this into a model of care for virtually all Medicare beneficiaries who are admitted for an acute care stay. And it is, mandatory for about a quarter of the hospitals in the country. It's around

740 hospitals total. And what Medicare did was they said, okay, we're going to take all the CBSAs. So these are core based statistical areas. parts of the country. And then we're going to take all the hospitals in that area and

all the hospitals in the chosen CBSAs random, so they picked random CBSAs, they're all gonna be included. Surgeons in one geographic area can't say, well, I don't wanna do this, so I'm just gonna go to the other hospital down the road that's not participating. Every hospital is participating in the area.

So again, these mandated participants have to be in this model for five years. They cannot exit the model voluntarily.

So that's essentially how the model works.

Alex (05:05) The biggest question, I guess, for you would be that the model itself is designed on a more of a macroeconomic scale. So these are more of a hospital path dependence and trying to control the variables that result immediately following surgical care. How do you suspect

that this model is going to impact clinicians, especially our target audience down the stream. So how is it going to impact musculoskeletal spend immediately following surgery, three months after surgery, six months after surgery?