The Ankota Healthcare Delivery Management Blog

Community Based Care is Effective for Substance Abuse Population

Posted by Will Hicklen on Mar 27, 2013 8:00:00 AM

Community Based Models Improve Care for Substance Abuse Population, while Lowering Costs to Health Systems and Payers.

describe the imagedescribe the image JH Shool of Public Health logo

Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care. The substance abuse population is very costly, and community based initiatives have  

To learn more about how Ankota technology is used to Plan, Coordinate and Deliver care in population health and community based models, click here  

Manage Community Based Care with Ankota Technology

A small proportion of patients accounts for a large proportion of health care costs.1-4 The prevalence of illicit drug use, prescription drug misuse, and alcohol abuse among these high cost patients is high and contributes to the poor control of their chronic illnesses. Therefore, the identification and treatment of these substance use disorders has the potential to significantly enhance the wellness of high cost, medically complex patients. Improved health outcomes may result in substantial cost savings as well.

The first step is to identify patients with these conditions. Since they have poorly controlled chronic illnesses, they often present to the emergency department and are often admitted to hospitals’ medical and trauma floors. Screening for substance use disorders in these settings is becoming standard-of-care for good reason. Not only is substance use a common underlying cause of their condition but the hospital admission represents an opportunity to engage and motivate patients to seek treatment for their substance use disorders.5

Ankota Care Coordination Technology Improves Care -- Click Here!

Once patients have been identified, the provision of a brief intervention for their substance use has been shown to be effective for several conditions in a variety of settings. For example, brief interventions targeting at-risk drinkers reduce subsequent emergency department visits.6 In addition, patients can be referred to more intensive outpatient substance abuse treatment settings at the time of the diagnosis in the emergency department or upon discharge from the hospital. Facilitating the patient’s transition to the new treatment site by engaging family and lower barriers such as transportation or literacy issues is important to maximize adherence.

Finally, successful graduates from substance use treatment programs benefit from periodic recovery check-ups.7-9 These continuing care programs range from weekly telephonic counseling contacts to quarterly in-home assessments. This process can also be applied to patients who have initially declined a higher intensity of care in order to maintain engagement and to provide continuing encouragement for indicated treatment. These programs have been shown to minimize relapse and to facilitate early referral to a higher level of care if relapse does occur. These programs also have the potential to achieve substantial cost savings due to decreased utilization of unplanned health services in including emergency department visits and in-patient admissions.

Manage Population Health Models with software from Ankota

The approach to the care of patients with substance use disorders requires facilitated communication among acute care providers, primary care providers, and substance use treatment programs. In addition, on-going contacts with patients who are in recovery, or who have not yet decided to seek treatment, requires supportive IT functions including algorithm-based scheduling, decision support, and point-of-care documentation. This type of system is being implemented in innovative health systems and promises to have substantial impact on the health of these high cost patients.


1.         Berk ML, Monheit AC. The concentration of health care expenditures, revisited. Health Aff.(Millwood.). 2001;20(2):9-18.

2.         Anderson G, Knickman JR. Patterns of expenditures among high utilizers of medical care services. The experience of Medicare beneficiaries from 1974 to 1977. Medical care. 1984;22(2):143-149.

3.         Zook CJ, Moore FD. High-cost users of medical care. The New England journal of medicine; The New England journal of medicine. 1980;302(18):996-1002.

4.         Wray NP, DeBehnke RD, Ashton CM, Dunn JK. Characteristics of the recurrently hospitalized adult. An information synthesis. Medical care. 1988;26(11):1046-1056.

5.         Pollini RA, O'Toole TP, Ford D, Bigelow G. Does this patient really want treatment? Factors associated with baseline and evolving readiness for change among hospitalized substance using adults interested in treatment. Addict.Behav. 2006;31(10):1904-1918.

6.         Bray JW, Cowell AJ, Hinde JM. A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Med Care. 2011;49(3):287-294.

7.         Dennis M, Scott CK. Managing addiction as a chronic condition. Addict.Sci.Clin.Pract. 2007;4(1):45-55.

8.         Scott CK, Dennis ML. Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction. 2009;104(6):959-971.

9.         McKay JR, Lynch KG, Shepard DS, Pettinati HM. The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-month outcomes. Arch.Gen.Psychiatry. 2005;62(2):199-207.



Topics: Community Based Care, transitional care, Dr. J. Hunter Young, Johns Hopkins HealthCare, Care Transitions

Entrepreneurs Growing Private Duty Home Care

Posted by Will Hicklen on Mar 22, 2013 10:06:00 AM

Private Duty Homecare Need Will Rise



Home Care Well Positioned to support Accountable Care models and Reduce Avoidable Readmissions

Longtime readers of this blog may recognize the article below-- it remains today the single most popular post on this blog. The growth in new home care businesses continues while existing providers are experiencing tremendous growth. The Bureau of Labor Statistics estimates that home care services will be one of the fastest growing jobs through 2020, and employment estimates from BLS and others range from 10% to as much as 20% annually. 

So is Private Duty Home Care a good business to be in? I'd say so. As compelling as the employment forecasts are, it does not begin to estimate the real size and scope of the problems that home care addresses. In this new era of Accountable Care, where major providers accept increasing risk and responsibility, the opportuity has never been greater for Home Care agencies to help better manage Care Transitions from hospital to home. This promises to be one of the greatest drivers of growth for home care over the next 10+ years. 

We're already in an unprecedented time of population aging, where soon 1 out of 6 people in the US will be over 65 years of age. It's also well known that the 65+ population will triple by 2030. Caring for seniors more proactively in their homes and in the community reduces hospital admissions, which is a key priority of Accountable Care models and reform. Readers are well aware of the readmissions penalties that hospitals already face and which are scheduled to increase significantly. Home Care is well positioned to be a key part of the solution.

Ankota's technology is used by home care agencies of all shapes and sizes to Plan, Coordinate, and Deliver Care. Contact Ankota for a free demonstration. 


Originally posted April 18, 2011

This post was provoked by a call from a family friend, Kelly, who is considering launching a business to provide non-medical, companion services in the home. Kelly knows that Ankota also provides software tools for Private Duty Home Care agencies, so she wanted to pick my brain about our experiences with companies like the one she is considering.

At Ankota, we have the good fortune to be able to meet and talk with many home care businesses. We definitely see trends in the market and have the opportunity to share some with you here on the Healthcare Delivery Management Blog. We're so confident about the growth in this market, we even offer FREE software to new startup agencies that qualify ( to learn more and see if your agency qualifies, or click here).

If you are reading this, odds are that you are already in the business of providing or coordinating home care services of some kind. Perhaps you are a home care provider, or are considering expanding your existing home health care business to include non-medical services. We're seeing rapid growth in non-medical home care, and the opportunities it presents for both new entrants and existing providers is compelling. Kelly’s call provoked me to think about the prospects of starting and developing a home care business such as this and prompted me to share parts of the discussion with our readers.

Entrepreneur Magazine on Home Care Opportunities

Thinking of starting your own agency? Why not? It’s an attractive business model to which the entrepreneurial minded are drawn. Entrepreneur Magazine wrote an interesting article five years ago anticipating the opportunity. The piece provided some good “getting started” advice that still resonates today. You can read the entire article here.

Home Care Business Opportunity at a Glance

The National Private Duty Home Care Association (NPDHCA) and the National Private Duty Association (NPDA) both provide a wealth of information on their web sites (click logos below to go to their sites). Both provide resources to help you with training and certifications and provide excellent research on the state of the industry and prospects for growth. It is worth spending some time on their sites to read about hiring practices, research existing agencies in your geography, and keep an eye on industry events. You should consider attending the associations’ annual meetings, too.

Private Duty Homecare Asoc NAHC



To Franchise or Not to Franchise… I won’t analyze here the merits of going it alone versus franchising, but would welcome comments on this post discussing the pros or cons of either. Franchising is definitely a consideration that anyone entering private duty home care should evaluate. If you know of a good article or other materials on this subject, please email the link and we’ll be happy to repost it here on Ankota’s Healthcare Delivery Management Blog.

Additional Resources:

Accredidation & Certification

Care Plans, Assessments

Human Resources Supervision

Additional Links

Topics: Home Care Entrepreneurship, Starting a Home Care Business, Private Duty Homecare Association, Private Duty Agency Software, transitional care, Home Care Technology, Will Hicklen, Home Care, NPDA, Care Transitions, Accountable Care Organizations, Avoidable Readmissions

Talking Care Coordination with Cheri Lattimer of CMSA, NTOCC

Posted by Will Hicklen on Mar 21, 2013 1:24:00 PM

Cheri Lattimer is one of most widely recognized leaders in Care Coordination today. Many of Ankota's readers recognize Cheri from her pioneering role as the Chair of the National Transitions of Care Coalition (NTOCC) and Executive Director of the Case Management Society of America (CMSA). This is an exerpt of a recent interview with Cheri about the new care coordination payments enacted by CMS and the opportunities that they present to providers.

Care Transitions Technology from Ankota

Ankota's technology is used by Hospitals, ACOs, and post acute providers to better manage Care Transitions, reduce readmissions, and improve outcomes. Providers of all types use Ankota's technology to better Plan, Coordinate, and Deliver care. Click on any of the blue buttons to contact Ankota and learn more. 

The field of care coordination, which spans the healthcare continuum, took a tremendous leap forward in 2013, when the Centers for Medicare and Medicaid Services (CMS) began reimbursing for care coordination-specific activities, chiefly centered around “transitional care management” performed in post-acute settings.

Two new codes – 99495 and 99496 – now allow physicians and qualified staff to achieve payment incentives for performing post-hospital follow-up services that aim to keep patients safe, on track with discharge plans, and ultimately out of the hospital.

Cheri LattimerRecently, Case In Point Weekly sat down with Cheri Lattimer, executive director of the Case Management Society of America (CMSA) and project director of the National Transitions of Care Coalition (NTOCC), to gain an industry perspective of these groundbreaking new codes.

Care Transitions Technology from Ankota

According to Lattimer, both CMSA and NTOCC were influential in CMS’ creation of the reimbursement codes, and they will continue to work for the healthcare industry to “go even further” in recognizing – and reimbursing – care coordination pursuits.

In the article below, Lattimer shares her perspective on care coordination, case management and the wider impact on the industry.

Q: What is the significance of the new codes focused on transitions of care?

A: The first thing is to recognize and applaud CMS, because it really is the very first time that they have recognized the need to align the incentives with the services around care coordination and transitions.

It also creates excellent support that it’s just not physicians but physician assistants (PAs) and advanced practice nurses (APNs) that are also able to utilize these codes. And, under those codes, the physicians are able to use nonphysician staff in their offices to be able to provide certain levels of codes.

We just expanded the reach of being able to provide the services, being reimbursed for the services, and the ability to improve the patient communication and care coordination.

Care Transitions Technology from Ankota

Q: What does this mean for the case management community?

A: First, the independent case manager who is not an APN or a PA is not able to bill independently under the code. But the services they provide in the offices definitely are covered under the codes.

Q: How do the new codes relate to other dominant movements within healthcare, such as accountable care organizations and medical home?

A: Between accountable care and the patient-centered medical home, and even focused on reducing hospital readmissions, this focuses in on that transition from the hospital back to the community, to the skilled nursing facility, or into the primary care office. You now have the continuity of being able to share that information, review that information, and follow up on that information based on coding – which is really a significant improvement on what you have seen in the past.

In the past, if a patient was discharged from the hospital, other that [clinicians] were supposed to ensure that documents got somewhere, there really was no follow up – but you need to reconcile the medications, see if the treatment plan has changed, be able to ascertain if there’s a new diagnosis from the hospital stay, etc.

What we’re done is really kind of connected the dots that were somewhat disparate prior to this. We have aligned performance with the payment incentive and we have acknowledged that this is a collaborative effort of the clinical team. It’s just not payment for individuals; it is acknowledging the multidisciplinary team and the ability to be able to support that from multiple directions.

Q: Will the change in post-acute care affect working relationships between post-acute clinicians and acute staff?

A: I would absolutely hope so. Because if both parties do bidirectional sending and receiving and the patient is part of this equation, along with their family caregiver, we are closing many of the gaps that we have seen in the past for having a safe patient and family caregiver transition.

If the collaborative team from the hospital is transitioning appropriately out into the community (to primary care, a specialist, or a skilled nursing facility), and if in receiving that [the post-acute clinical team members] are also following the coordination and attributing those transitional care management services, we not only have provided a better experience fro the patient, we have improved patient safety. And, in fact, the reality is we probably have reduced a hospital readmission because we’re closing the gaps that often are related to that. This isn’t going to work if we don’t have good collaboration.

If you look at the codes and you look at the scope of which those codes actually cover, and then you go back and look at the services that can be provided in a non-face-to-face by a physician or qualified staff, you have to say there’s no way this should not improve.

Care Transitions Technology from Ankota

Q: Why should physicians and staff be happy about these new codes?

A: On the outpatient side, where these codes have the impact and can be charged, many times the argument has been in the past that physicians in private practice, in clinical practice, cannot afford to have those services or have a nurse a case manager provide these services – just because they’re not reimbursed. This kind of shoots an arrow into that argument and there is funding that is available for that and, utilized appropriately, it does allow you to provide those services.

It helps to align not only the performance along with the payment initiative to be able to support the provider and the patients and the family caregivers in this process.

Q: Overall, where do you hope to see the industry go from here?

A: This is a great start, but it’s not far enough. Care coordination occurs at every part of our continuum. It isn’t just from the hospital to the community. It is within every aspect of what patients and family caregivers go through. The more medically complex they are, the more difficult those transitions become.

I applaud CMS and I think we can go even further and with that we can enhance patient safety and the healthcare experience for all of our patients and their family caregivers.


The upcoming webinar, Newsflash: CMS Now Reimbursing for Care Coordination: Everything You Need to Know About the New CMS Codes, will take place Wednesday, March 20, 2013.

 The 5th Care Coordination Summit also covers the new CMS codes. Discover more about the agenda here. The Care Coordination Summit takes places May 7-8 in National Harbor, Md.    

Topics: Care Coordination Payments, Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, ACO

Developing New Management in the Era of Accountable Care

Posted by Will Hicklen on Mar 19, 2013 8:30:00 AM

Call this post "Management Lessons for Acccountable Care." There is a definite lack of experienced leadership in Accountable Care models, in models that address avoidable readmissions, and that are focused on improving Care Coordination and delivery. Since this is so, does it really make sense to just re-assign existing managers to these new models, where they really are not experienced?  

NY Times Logo Accountable Care

Ilene Gordon photo

In management, we sometimes call these "re-treads." Like when you put new treads on old tires. Sometimes there are great reasons to do this, but sometimes there are shifts in markets that open opportunities for new talent to emerge. 

Take a look at this discussion in the New York Times with Ilene Gordon, CEO of Ingredion, encouraging employers to promote people even before they're really ready for the job. This might provoke some thinking among post acute providers and hospitals alike, whether you are engaged in an ACO model today or not.   

Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

While not written specifically for health care, this drives home the point that when innovation is needed, hire and promote innovative people who get things done. We're in a fascinating time in health care, and many of Ankota's customers have shared concerns that they may not have the right staff to lead and grow their businesses the way they need to.  

The CEO of a major hospital system in the midwest said, "I know we don't have the right leadership team to tackle this, but I also don't think it exists out there, so what's my choice?"

This is not just a hospital or ACO problem. Another Ankota customer, the owner of a Physical Therapy agency with 70 therapists in Florida recently said to me, "We have therapists running this business and they know nothing about business. I need someone who can market and run the business, including operations and finance." She went on to explain that she believes that therapy providers have the greatest opportunity ever right now, and she believes she will have perhaps 2 years to establish her business as the preferred therapy provider for ACOs in Florida. And that's why we're working with her, by the way. Click the blue button below to learn more about how Ankota helps therapy agencies operate efficiently and provide huge value for ACOs.

Learn How Ankota Helps Therapy Agencies

Ilene Gordon advocates developing young and innovative talent, even if inexperienced. 

One of my favorite discussions in this piece is her response about identifying talent:

Q. How do you know if somebody’s able to stretch into a big new job?

Gordon: "’s about tenacity. It’s never giving up." She continues, "I look for young people who have a lot of energy, and who treat other people well, because we’re not looking for bullies. Some people push their way through things and they’re not collaborative. I look for people who don’t give up, who are very focused and organized but are also able to collaborate with other people, because in today’s organizations, you actually may not have anybody directly reporting to you but may have a team of 10 people from other parts of the organization. They’re your virtual team."

Read the New York Times interview with Gordon in its entirety here 


Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

Topics: Care Coordination, transitional care, Will Hicklen, Accountable Care Organizations, Avoidable Readmissions, Managing Post Acute Care

20 New Community Based Care Transitions Initiatives Added

Posted by Will Hicklen on Mar 18, 2013 8:30:00 AM

CMS Selects 20 Additional Sites for the Community Based Care Transitions Program

Sites Now Total 102 across 40 states

CMS logo

3/7/2013: The Centers for Medicare and Medicaid Services (CMS) announced its fifth round of funding for 20 additional participants in the Community-based Care Transitions Program (CCTP). Authorized by the Affordable Care Act, the CCTP provides funding to test models for improving care transitions for Medicare patients at high risk for readmission by using services to manage patients’ transitions effectively.

Ankota Technology for Community Based Care Transitions Programs

With the addition of these 20 sites, the CCTP will provide care transition services to nearly 700,000 Medicare beneficiaries in 40 states across the country. This new batch of grants brings the total number of sites to 102. 

To learn more about how Ankota's technology is used to manage Community Based Care Transitions, click on one of the blue buttons or click here 

More about the CCTP from CMS:

The Community-based Care Transitions Program (CCTP), created by Section 3026 of the Affordable Care Act, tests models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries. The goals of the CCTP are to improve transitions of beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high risk beneficiaries, and to document measurable savings to the Medicare program.

Ankota Technology for Community Based Care Transitions Programs

Click on the map below to visit the interactive version and learn more about Community-Based Care Transitions participants in your state. In addition to needing advanced care coordination technology from Ankota, these programs offer tremendous opportunities for post acute providers in the respective areas to cooperate with CCTP initiatives to provide services to patients outside of hospital settings. Post acute services like home health nursing, physical and occupational therapies, and DME providers play a critical role in delivering care outside of hospital settings that improves outcomes, reduces readmissions, and lowers overall costs. 



Ankota Technology for Community Based Care Transitions Programs




Topics: Care Coordination, Care Transitions

Bill Threatens 40% Cut to Care Transitions Funding

Posted by Will Hicklen on Mar 15, 2013 10:46:00 AM

"If we fail to continue to promote and utilize proven methods for improving care transitions, patient outcomes will suffer at higher costs to taxpayers."

-Cheri Lattimer, NTOCC Executive Director

NTOCC logo

read this story in its entirety on the NTOCC web site 

The National Transitions of Care Coalition (NTOCC) today urged policymakers to reject a precipitous reduction of federal funding that would serve to improve care transitions for patients at the community level and, in doing so, vastly reduce health care spending. The call from NTOCC followed the release of the Senate’s proposed “Continuing Resolution” legislation, a package that would continue the funding of the federal government through September but make certain cuts to federal programs. NTOCC is the nation’s leading alliance of multidisciplinary health care organizations and stakeholders dedicated to providing solutions that improve the quality of health care through stronger collaboration between providers, patients, and family caregivers.

Ankota Technology to Manage Transitions of Care

 Cheri Lattimer, NTOCC Executive Director, called on Congress to reject the proposed 40 percent cut to the Community-based Care Transitions Program (CCTP) that was created as part of the Affordable Care Act. The CCTP provides funding for local programs that reduce hospital readmissions and expenses, and improve patient health outcomes by facilitating better transitions of care for patients who move from one care setting to another.

“As many families, caregivers and patients themselves know,” said Lattimer, “those who require care — particularly the elderly and individuals with chronic illnesses— face significant challenges when moving from the hospital to home, from a care facility to the hospital, or between other care settings.” She added, “Poor transitions of care mean medication errors, duplicative tests and other mistakes that frequently cause hospital readmissions, raise costs of care, and diminish the quality of patient outcomes.” Lattimer noted that the CCTP is a critical resource for advancing improved transitions, and that reductions to program funding pose grave threats to important and cost-effective improvements – those initiatives that are occurring, and more that are needed – aimed at patient transitions and related care. “If we fail to continue to promote and utilize proven methods for improving care transitions, patient outcomes will suffer at higher costs to taxpayers,” she said.

On Monday, bipartisan leaders of the Senate Appropriations Committee released their proposed Continuing Resolution, which strips $200 million from the $500 million that had been appropriated for the life of the CCTP. NTOCC leaders urge the Senate and Committee leaders to strip the provision from the final Continuing Resolution.

Ankota Technology to Manage Transitions of Care


About the National Transition of Care Coalition 
The National Transitions of Care Coalition is a 501(c)(4) dedicated to addressing a serious U.S. health care issue: filling the gaps that occur when patients leave one care setting and move to another care setting. These transitions include patients moving from primary care to specialty physicians; moving or transferring patients from the emergency department to intensive care or surgery; or when patients are discharged from the hospital to home, assisted living arrangements, or skilled nursing facilities. The U.S. health care system often fails to meet the needs of patients during these transitions because care is rushed and responsibility is fragmented, with little communication across care settings and multiple providers.

Topics: Care Coordination, transitional care, Will Hicklen, Care Transitions

New Opportunities for Home Health Care Delivery Models

Posted by Will Hicklen on Mar 14, 2013 1:01:00 PM

At $25 BILLION annually, the pre term birth crisis is roughly equal in cost to the Avoidable Readmissions problem. The solution is to utilize post acute providers like home health nursing to care for expectant mothers in the community. 

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The emergence of health care "ecosystems" -- that operate efficiently and coordinate care effectively among providers -- provides signifcant new opportnities for post acute providers. Home Health Nursing, HME / DME companies, physical therapy agencies, Private Duty Home Care agencies and others have opportunities before them to partner with health systems and Accoutable Care Organizations, or ACOs, to develop new revenue while simultaneously improving patient care in the community. As more care is delivered outside of hospitals, post acute providers will serve as the primary delivery channel.

Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

Ankota is often asked for guidance to help post acute care providers identify new opportuities and new programs to leverage. Here is one tremendously valuable opportunity to improve care and reduce costs for an expensive, high risk population. Post acute providers should partner with local health systems to address the pre term birth crisis. 

Ankota's Chief Medical Officer, Dr. J. Hunter Young, points out that premature births in the US cost the healthcare system $25 Billion annually. Additionally, the "cost tail" is a long one, where pre-term babies who consume expensive care at birth tend to consume a disporportionate share of healthcare services for the rest of their lives. This is an entirely addressible problem during pregnancy, but is best suited to be addressed in the community using post acute providers and community based staff as the delivery channel. 

Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care.  

Ankota Technology to Manage Transitions of Care
Nearly 500,000 babies are born too early in the US every year.1 As the leading cause of infant mortality and long-term disability in children, the preterm birth rate between 12 and 13% extracts a very high cost on infants and families. This burden is not equally shared. In 2007, the preterm infant mortality was almost 3.5 times higher among infants of African American mothers compared to white mothers.1 In addition, the societal cost of preterm birth is considerable, estimated at more than $26 billion per year.2 Approximately $17 billion of this total goes to the medical care of the infant, accounting for approximately 50% of birth-related spending.2 A significant proportion of this cost supports the frequent admission of the preterm infant to the neonatal intensive care unit.

The good news is that we know many of the risk factors for preterm birth3 and, therefore, we can identify women in time to intervene. Just as important, we have an intervention that has been proven effective in preventing preterm birth among women with certain risk factors.4 Progesterone is a naturally occurring hormone that is involved in maintaining pregnancy. There is very strong evidence that progesterone administration significantly reduces the risk of preterm birth in women who have had a preterm birth in the past.5 There is also very good evidence that progesterone reduces the risk of preterm birth in women who have evidence of a shortened cervix on ultrasound.4 Given this evidence, progesterone administration has become the standard of care in the prevention of preterm birth in women with a history of preterm birth.

The use of progesterone has the potential to significantly reduce the burden of infant mortality and disability in children. In addition, its use has the potential to significantly reduce health care costs. In a paper published in 2007, the authors found that the universal treatment of eligible women with progesterone would save approximately $2 billion in annual direct medical expenses.6 The financial data is old and, therefore, this is likely a significant underestimate of the true cost savings.

Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

Despite the proven benefit, progesterone is still underutilized. The data is sparse but a survey of Maternal-Fetal Medicine specialists in 2005 found that only 67% used progesterone to prevent preterm birth.7 The rate of use by non-specialists is likely substantially lower. Furthermore, progesterone administration is inconvenient, requiring weekly injection or daily vaginal suppositories. Therefore, adherence among women prescribed progesterone is likely low.

Given the proven benefit of progesterone treatment on birth outcomes and costs, it is important that health systems improve the process of identifying, treating, and supporting women at risk for preterm birth. Approaches to improve adherence to progesterone treatment include education of care providers, facilitation of progesterone compounding and delivery, the administration of progesterone in the patient’s home, periodic assessment of adherence, and patient support through education and other efforts such as motivational interviewing.  Once implemented, a systematic approach to the care of women at risk for preterm birth could have a substantial impact on birth outcomes and costs. Given the very high direct medical cost for an infant born early, approximately $33,000 by one estimate,2 a small decrease in the rate of preterm birth can have a substantial impact on birth-related expenses.

Contact Ankota for Accountable Care Solutions

1.         Preterm Birth. 2012; Accessed March 11, 2013, 2013.

2.         Behrman R, Butler A. Preterm birth: causes, consequences, and prevention. Nataional Academy Press. Washington DC: Institute of Medicine; 2006.

3.         Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. Jan 5 2008;371(9606):75-84.

4.         Ransom CE, Murtha AP. Progesterone for preterm birth prevention. Obstetrics and gynecology clinics of North America. Mar 2012;39(1):1-16, vii.

5.         Dodd JM, Flenady VJ, Cincotta R, Crowther CA. Progesterone for the prevention of preterm birth: a systematic review. Obstet Gynecol. Jul 2008;112(1):127-134.

6.         Bailit JL, Votruba ME. Medical cost savings associated with 17 alpha-hydroxyprogesterone caproate. American journal of obstetrics and gynecology. Mar 2007;196(3):219 e211-217.

7.         Ness A, Dias T, Damus K, Burd I, Berghella V. Impact of the recent randomized trials on the use of progesterone to prevent preterm birth: a 2005 follow-up survey. American journal of obstetrics and gynecology. Oct 2006;195(4):1174-1179.



Topics: Physical Therapy, Population Health IT, Home Care Best Practices, Care Coordination, transitional care, HME, DME, Dr. J. Hunter Young, Care Transitions, Accountable Care Organizations

ACOs Now Total 428 as Growth Continues

Posted by Will Hicklen on Mar 12, 2013 11:00:00 AM

In 2012 and the beginning of 2013 ACOs have nearly tripled in number again, with growth coming among all types of sponsoring entities.  

There are 428 ACOs now existing in 49 states, as ACO growth has also continued apart from the Medicare program.

Health Affairs Blog


David Muhlestein is an analyst at Leavitt Partners and writer for HealthAffairs Blog

Contact Ankota for Accountable Care Solutions

On January 10, 2013 the Centers for Medicare & Medicaid Services (CMS) announced that 106Accountable Care Organizations (ACOs) will join the Medicare Shared Savings Program (MSSP).  CMS reports that this brings the total number of MSSP ACOs to “more than 250” and that they cover up to 4 million Medicare beneficiaries.

These new Medicare ACOs, though, only tell part of the accountable care story.  ACO growth has also continued apart from the Medicare program with 428 total ACOs now existing in 49 states.  Additionally, physician groups have overtaken hospital systems and have now become the largest backer of ACOs.

Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

Background Of The ACO Program

Public sector. ACOs are health care entities intended to lower health care costs, improve quality outcomes and improve the experience of care.  The premise of the ACO is that each of these results can be obtained by moving away from volume-driven fee-for-service based reimbursement toward payment models that reward care coordination and quality outcomes.

While the ACO title is relatively new, the general accountable care framework was previously tested in the Medicare Physician Group Practice Demonstration (PGP), which was enacted in 2000 and ran, with ten participating organizations, from 2005-2010.  After the PGP showed modest success, the Federal Government formally embraced this approach to delivering care through the passage of the Patient Protection and Affordable Care Act in 2010.

The health reform law and subsequent regulations establish a framework where provider groups agree to care for a population of patients with the goal of reaching or surpassing predetermined cost and quality benchmarks.  If the ACO manages to meet all the quality benchmarks and the population’s cost of care is below the established threshold, the ACO is able to share in the “savings” (the difference between the actual cost and benchmark cost).  The first 32 Medicare ACOs, called “Pioneer ACOs” were announced in late 2011.  In 2012, 27 shared savings ACOs were announced in April and 89 more (later decreased to 87 due to attrition) joined in July.

Private sector. Simultaneous to the CMS-backed plan, private sector ACOs were also forming.  Prior to the first Pioneers joining the CMS program, over 150 private sector ACOs were already operating or announced and that growth continued through 2012.   Due to the legislative nature of the program, MSSP ACOs are structurally similar with common payment arrangements, while private ACOs have more flexibility in designing accountable care contracts.  Many private sector ACOs do mimic the shared savings model of the MSSP, but others have moved to full or partial capitation models, bundled payments, retainer agreements, in-kind services and subsidies provided by payers, and pay-for-performance incentives.

Similar to the MSSP, most of these arrangements also require some form of quality benchmarking to achieve full payment.  Operating as a MSSP or working with private payers does not require an exclusivity agreement, and many ACOs simultaneously contract with private payers and CMS.  Additionally, many state Medicaid programs, either directly through the state Medicaid office or via a Medicaid managed care plan, are actively negotiating accountable care agreements with providers.

Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care

How Many ACOs Are There?

I am part of a team that has been actively tracking and studying ACOs, both Medicare and private sector, since 2010.  We identify ACOs from press reports, news articles, government announcements, news releases, conferences, personal and industry interviews, and other public records.  We collect general information on ACOs from public sources and then interview ACOs to learn more about specific payment arrangements, approaches to coordinating care, and plans for the future.

To date we have interviewed approximately 80 different ACOs and will continue to interview more.  We include on our list of ACOs entities that self-identify as being an ACO, are part of the formal MSSP, or that mimic ACOs in objectives but have decided to not use the ACO name (such as Community Care Organizations).

As of the end of January 2013, we have identified 428 different ACOs throughout the country.  (See exhibit 1 below, click to enlarge.)  In mapping ACO growth and dispersion, we identify hospitals that are owned by, or affiliated with, the ACO and use their location as a representation of the ACO’s geographic location, so a single ACO may exist in multiple states.  If an ACO does not directly affiliate with hospitals, such as with some ACOs led by physician groups, then the office of the ACO was used to define its location.  Three insurer-led ACOs with a national footprint were not mapped.

Number of ACOs by State

The continued growth of the accountable care movement is apparent, as ACOs have spread to 49 states, Washington DC and Puerto Rico.  The only state without an ACO is Delaware, though there have been discussions about forming an ACO in the state and ACOs in neighboring states may cover some Medicare patients there.  California, Florida and Texas lead the nation with 46, 42 and 33 ACOs respectively.



Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care


Generally, higher-population states also have higher numbers of ACOs, and extensive ACO growth has continued throughout the Midwest and on the West Coast.  The least amount of growth has occurred in a band running from the Deep South, through the Great Plains and toward the Mountain West.

State estimates provide insight into broad trends, but any potential competition among ACOs will occur at the market level.  Hospital Referral Regions (HRRs) are geographic regions defined by the Dartmouth Institute for Health Policy and represent markets where patients are likely to be referred for tertiary care.  (See exhibit 2 below, click to enlarge.)  They represent a good proxy for areas where ACOs are most likely to compete for patients.

ACOs by Hospital Referral Region

ACOs are expanding their market coverage, as now only 64 (21 percent) of the 306 HRRs do not have an ACO present.  Growth is still focused around population centers, particularly along the West Coast and the Northeast.   In the past year ACO, growth has increased dramatically around Phoenix, Baltimore/Washington DC, Indianapolis, Omaha, and Portland Maine.  Minneapolis, Central Ohio and the large Texas cities continue to have high numbers of ACOs.  Boston and Los Angeles have the highest concentration of ACOs with 19 apiece, followed by Orlando with 13.  Rural areas, particularly in the South and Appalachia, continue to have a paucity of ACO activity.

Who Is Involved In The Movement?

A major part of the ACO design is that health care providers are more involved managing the health and care of a population with some level of attendant risk for the amount of care provided.  That does not mean, though, that providers are the only people that are encouraging ACO growth.  ACOs do require significant provider involvement, but multiple groups can provide the direction or leadership in the creation of the ACO.  Specific entities that sponsor the ACO come in many types, but four general categories have emerged: hospital systems, physician groups, insurers and community-based organizations.  (See exhibit 3 below, click to enlarge.)  Community-based organizations are non-profit, non-medical entities that bring together the payers and providers that will contract to form the actual ACO.

Muhlestein Exhibit 3 Number of ACOs

A year after the passage of the Affordable Care Act (first quarter 2011), hospital system-led ACOs outnumbered all other types at a rate of two to one, but there were still relatively few (71) ACOs.  By the end of 2011, ACOs had doubled in number; hospitals still accounted for a majority of all ACOs, but physician groups and insurers saw faster relative growth.

In 2012 and the beginning of 2013 ACOs have nearly tripled in number again, with growth coming among all types of sponsoring entities.  Of the 282 new ACOs in this period, 158 (56 percent) are sponsored by physician groups, 103 (36.5 percent) by hospital systems, 17 by insurers (6 percent) and 4 by community-based organizations (1.5 percent).  The initial movement of ACOs was led by hospital systems, but physician groups have now surpassed them as the most common sponsoring entity among all ACOs.  Health insurers, though they may not appear as the sponsoring entity, continue to play a strong role in ACO formation with financial backing and a willingness to explore novel payment models.


Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care


While physician group-led ACOs are most numerous, they are generally smaller than those run by hospitals.  CMS reports that approximately half of all Medicare ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries, meaning hospital-led ACOs in the MSSP must have, on average, at least twice as many patients as those led by physician groups to cover the estimated 4 million Medicare beneficiaries.  Our research has found similar results among private sector ACOs, with hospital-led ACOs having, on average, considerably larger ACO populations than those led by physician groups.  While physician groups now sponsor the majority of ACOs, hospital systems still oversee the larger volume of total ACO patients.

The Next Step For ACOs

Based on reviews of these ACOs and interviews with ACO leadership, there are some significant differences across ACO models in how they try to achieve savings and manage their patient population, particularly between those sponsored by hospital systems and physician groups.  Physician groups have the general approach that ACOs save money by keeping a patient out of the hospital and seek to accomplish this by managing patient care in outpatient settings, such as by using patient-centered medical homes to coordinate care among specialists.  Hospital system-led ACOs, meanwhile, focus on better managing patients once they have been admitted to a hospital by trying to coordinate care among departments and providers.  Both types of entities are trying to break down artificial silos so that the appropriate providers will work together to treat the patient at the proper time, as well as follow best practices and more effectively monitor their patient population.

Each of these approaches has merit.  An ideal ACO will focus on keeping patients from entering a hospital and cost-effectively treating those that are admitted.  A major challenge to achieving this lies in sharing governance for the ACO and responsibility for a patient population between organizations that are capable of efficiently managing patient care across the whole continuum of health care services.

Within a level of care providers, are making great strides to improve care coordination, but between care levels (such as between inpatient and outpatient), there is less progress being made.  If a large physician group or a hospital system can achieve savings by working alone, they have little incentive to partner with another provider group as equals to further improve patient care.  The next step in the accountable care movement will require a recognition that levels and locations of care are artificial constructs and that patient care should instead be focused on treating the patient appropriately; whether the care is being reimbursed by Medicare Part A, B, D or a private payer should matter much less than focusing on connecting patients with the right provider in the right location for their illness acuity.  This, though, will require large physician groups and hospital systems (and eventually post-acute and long term care providers) to work together and align their goals around patient care.  This does not require wholesale integration of providers, but that may be the result in some markets.

The Future Of The Accountable Care Movement

The accountable care movement is progressing rapidly, as many provider groups throughout the nation are officially adopting the title of ACO and are adopting some form of contract that encourages population management and cost minimization.  While ACO growth will undoubtedly continue for at least the immediate future, it still represents a small minority of care delivered in the United States.  Whether the numerous organizations that are cautiously observing ACOs from the side will ever take the plunge and adopt accountable care models will largely depend on the success of these early adopters.  It’s much easier to adopt a new payment model when your peer institutions achieve success rather than end up millions in the red.


Ankota Technology Helps ACOs Achieve the Triple Aim of Health Care


ACOs are still a work in process and their eventual success or failure is still to be determined, but the accountable care movement’s influence on the American health care system is already being felt.  In 2013, many ACOs will complete their first year under a risk-based ACO contract, and their early results will influence how payers, providers and policymakers experiment with future iterations of accountable care.  If the results are good, then the ACO model may become the dominant form of health care in the United States over the next decade.  If the results are negative, accountable care may never gain a permanent foothold in our delivery system.  The health care system will be watching to see how the accountable care movement plays out.

Topics: Community Based Care, Population Health IT, Care Coordination, transitional care, Will Hicklen, Care Transitions, Accountable Care Organizations, ACO, ACO Technology

Patient Centered Medical Home and Community Based Care Models

Posted by Will Hicklen on Mar 11, 2013 10:08:00 AM

Community Based Care Models Gaining Momentum with PCMH in Urban Communities

by J. Hunter Young, MD, MHS 

J. Hunter Young, MD, MHSJohns Hopkins Medicine logo

Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care. Managing Care Transitions has emerged as a critical element in reducing avoidable readmissions and lowering overall costs, and health care providers are looking for information to guide them in the creation of these programs. 

To learn more about how Ankota technology is used to Plan, Coordinate and Deliver care in community based models and PCMH, click here  

Technology for Patient Centered Medical Home (PCMH)

Improving health outcomes and lowering healthcare costs is challenging and usually requires the effort of a multidisciplinary team of professionals. The Patient-centered Medical Home (PCMH) is a team-based care delivery model that addresses this reality and has been effective in achieving better care in many settings. Early evidence suggests, however, that the PCMH model is not as effective in urban settings, largely due to the inability of clinic-based teams to engage urban residents and to address the social, behavioral, and environmental determinants of health that are prevalent in poor communities.

In response, many programs around the country are beginning to supplement their traditional PCMH model with community-based teams dedicated to urban neighborhoods. As demonstrated by Medicare’s Coordinated Care Demonstration Programs, face-to-face interactions between the PCMH care coordination staff and their patients are an essential element of effective care coordination programs. This may be especially true for low resource, urban communities where trust of the health system can be low. Community-based health workers may also better understand the neighborhood-specific barriers to care that limit access for our urban patients.

Learn How Ankota Technology Reduces Readmissions

Community health teams are defined as community-based, multidisciplinary health staff that support primary care and provide linkages between patients and families, and the medical home and the community. Community health teams wrap-around and enhance the capacity of primary care practice.  Core functions of Community Health Teams include patient engagement and assessment, health and social service navigation, mitigation of barriers to care, and self-management support including motivational and emotional support, disease-specific knowledge reinforcement, and on-going monitoring. These functions complement those performed by clinic-based care management staff and together encompass the 6 domains that are critical to chronic disease management as first described by Wagner.1 Conceptualized in 1996, the Chronic Care Model (CCM) addresses these barriers to patient-centered, high-quality, cost-effective care and has become the standard framework guiding efforts to improve care for patients with chronic illness. The CCM includes 6 elements: 1) health care organization, 2) delivery system design, 3) clinical information systems, 4) decision support, 5) self-management support, and 6) links to community resources. These elements support team-based care that promotes and supports activated, informed, and empowered patients. 

While enhanced PCMH models have only recently been implemented, the early results are encouraging. As presented in a webinar at the National Academy for State Health Policy and sponsored by the Commonwealth Fund in April 2012, preliminary analysis of programs in Alabama, North Carolina, and Vermont have demonstrated decreases in emergency department utilization, overall health care expenditures, and improvements in HEDIS-based performance measures. Many more programs employing community-based teams have been recently funded through other CMS mechanisms.

Therefore, we can expect to see results from these programs in the coming years. 

Ankota Technology to Manage Transitions of Care


1.         Wagner EH, Austin BT, Von Korff M. Improving outcomes in chronic illness. Manag.Care Q. 1996;4(2):12-25.



Topics: APTA, PCMH, Care Coordination, Dr. J. Hunter Young, Johns Hopkins HealthCare, Care Transitions, Accountable Care Organizations, Avoidable Readmissions, Patient Centered Medical Home

Philips Healthcare Address to the HME Industry

Posted by Will Hicklen on Mar 5, 2013 12:44:00 PM

"We will need to find ways to do more with less."

Phillips Health Care Letter to the HME Industry

Philips Respironics

Philips Healthcare: "Along with you, we are disappointed by the recent CMS Competitive Bidding Round 2 Reimbursement Cuts announcement."

HMEs Find Ways to Do More with Less - Click Here!

March 5, 2013

Dear Homecare Provider:

Along with you, we are disappointed by the recent CMS Competitive Bidding Round 2 Reimbursement Cuts announcement. Knowing the provision of many life-saving homecare products and services is so critical to the success and even to the survival of providers like you, we are also disappointed by the extent of those cuts and the lack of transparency demonstrated throughout Round 2 of the Competitive Bidding process. At this crucial time, we remain committed to working as your ally to find viable solutions for these changing times. We will continue our efforts to drive innovative solutions and to provide added value opportunities for you and your business, while also continuing our efforts in Washington to influence policy in a way that will benefit all in the long term.

Faced with this unfortunate development, the number one priority for all of us must be to preserve the integrity of patient care. We will need to find ways to do more with less. Fortunately, ongoing collaboration with you has enabled us to introduce meaningful technologies and programs that may help reduce some of the sting. Tools like EncoreAnywhere were developed with input from providers like you and quickly became an invaluable resource to care teams who need efficient, remote access to vital patient information.

Today, patients are now able to manage more of their own care through feedback, troubleshooting and motivation with the use of SleepMapper, a new-to-the-industry innovation that was, again, inspired by our customers. Ideas such as the innovative Fit for Life program which offers resupply services with the purchase of a mask were developed for the changing industry model and are there to encourage long-term patient compliance, and to help you deliver practical ongoing care with less strain on your resources. REMstar Pro with Auto-Trial/CPAP-Check can provide efficient patient management as it helps to optimize pressure settings for home sleep testing patients, while providing them the long-term benefits of fixed pressure. Homecare provider focused retail programs and merchandising tools help to expand your offerings into new solutions beyond managed care. And our robust education and Partner Programs will be further bolstered to help you stay informed and stay a step ahead. 

HMEs Find Ways to Do More with Less - Click Here!

We approach our pledge to homecare providers like you with more resolve than ever. We will continue to lead the drive toward healthier patients, healthier practices and healthier businesses. And you can be sure we will be working even more closely with you to improve the likelihood of ongoing success. In the coming weeks and months, our team will be reaching out to you regularly to discuss your needs and present specific, real-world solutions that can help you immediately and set the stage for your future success.

The Competitive Bidding Round 2 Reimbursement Cuts is just the latest evidence that our industry is changing. Undoubtedly, we will face countless new challenges on our journey ahead. But through a concerted and collaborative effort, we will find optimal solutions and emerge stronger. Those who are open minded, willing to adapt and able to make the transition will be the ones who will ultimately realize success. As your allies, all of us at Philips Respironics are committed to help you make that transition.

We look forward to working with you through this latest challenge. In the interim, we want to hear from you. Share your thoughts and ideas by contacting us at



Brent Shafer
Philips Home Healthcare Solutions
John Frank
Sr. VP/GM, Sleep and Respiratory Care
Philips Home Healthcare Solutions
Tel: 724-387-5200
Fax: 724-387-5010

Topics: HME Delivery Operations, Health Care Reform, Care Coordination, HME, DME, Will Hicklen, Accountable Care Organizations, telehealth

The State of Physical Therapy in 2013

Posted by Will Hicklen on Mar 4, 2013 9:15:00 AM

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More great stuff from our friends at,  

"I imagine more of a PT civilian superhero, dressed in khakis and a polo shirt, equipped with outcome measures, soft tissue mobilization tools, needles, the critical thinking of MacGuyver and manual healing powers rivaling Mr. Myagi."

--Paul Killoren PT, DPT on

All kidding aside, what is the real state of the PT industry? Paul shares a more pragmatic analysis in his own state of the profession address, which you can read below.

One critical area not discussed in the article is the need for Physical Therapists, Occupational Therapists, and Speech Therapists to align more closely with Care Transitions initiatives and Accountable Care models. These models, which focus on reducing readmissions, improving patient experiences, and lowering overall costs, will increasingly incfluence more therapy business in the market. Care Transitions programs and Accounable Care providers will act as "aggregators" for many services including (but not limited to) therapy. Aggregators, a term used in many other markets, refers to organizations that have the ability to influence large volumes of business. Therapy and other types of providers have traditionally called these organizations "referral sources." More than just referral sources, these organizations will become even more powerful in directing large numbers of patients to other providers with which they cooperate.  They are already seeking to formalize relationships to better manage workflow and understand the "performance" of their partners. Therapy practices should align with these business models by providing exceptional service to patients, running their businesses electronically, and offering ways to make doing business with them easier.

To learn more about how Ankota helps Therapy providers better manage operations and coordinate care with other providers, click on this ccool blue button

Learn How Ankota Helps Therapy Agencies


State of the Profession Address: The Image of Physical Therapy in 2013

By: Paul Killoren PT, DPT

physical therapy image

Pick any search engine and type in “physical therapy.” Take a second to look at the top images of physical therapy from this search. Parallel bars, ankle weights and lower extremity stretches. Writing this on the rebound of my “bumpy ball and Tiger balm” tantrum I could easily fall back into the professional despair of misrepresentation (and who knows I may just end up there), but I actually have approached 2013 with an optimistic rejuvenation on the trajectory of physical therapy.

Google doesn’t match the semblance of PT I see through rose-colored lenses. Personally, I imagine more of a PT civilian superhero, dressed in khakis and a polo shirt, equipped with outcome measures, soft tissue mobilization tools, needles, the critical thinking of MacGuyver and manual healing powers rivaling Mr. Myagi. I guess we can meet somewhere in the middle.

But with less applause and likely more substance than the presidential State of the Union address, I thought I would offer my opinion on the State of Physical Therapy for 2013. I propose these thoughts in three categories: Things we as physical therapists have being doing right, things we can work on and challenges we face in 2013. A proverbial good, bad and ugly analysis, if you will.

What have physical therapists been doing right coming into 2013?

  1. Embracing Social Media – It took long enough, but there is now a definite physical therapy presence on blogs, Facebook, and Twitter. This will be a major factor in the “virality” of PT, which will only increase exposure to other health care professionals and the general public.
  2. Concentrated More on Specialization – This could easily go into the “things we can still work on,” but I have already noticed more PTs promoting their specialties versus treating everything possible. I submit that PTs must remain capable to manage every sort of musculoskeletal pain that walks into our physical therapy clinic. But promoting specialties in women’s health, TMD, sports performance, chronic pain or emphasizing specialized skill sets like Triggerpoint Dry Needling, Graston, and manual certifications is what will likely deepen our footprint as health care “specialists.”
     physical therapist
  3. Patients First – With tumult surrounding legislation, reimbursement and interdisciplinary ignorance, PTs could easily lose focus on the absolute cornerstone of our profession – our patients. We have the unique opportunity to spend more time with our patients and provide care than any other health care provider and the exceptional privilege to affect our patients for life. Value that.
Learn How Ankota Helps Therapy Agencies

What can physical therapists work on in 2013?

  1. Standardization of Care – It has been discussed before and the alphabet soup of titles and certifications has only worsened, but that isn’t even my issue. I feel we should promote ourselves as PTs first, foremost and exclusively, saving the credential tags for written purposes only. But my main point is that when a patient goes to a physical therapist they should have the expectation that they are seeing an expert with proficiency of musculoskeletal diagnosis and management of their condition. It should be our daily goal to uphold those expectations.
  2. Advocacy – This can always improve and although I think we are slowly catching up to other health care providers, our historic deficiency in promoting our profession has set us back. These efforts will ideally improve on the individual, community and national level. And yes, that may involve being a bit more “sales-y” than you are typically comfortable with. But honestly, you are “selling” health and pain-free function, not a used car. It’s not that bad.
  3. Break Out of The Insurance-Based Practice Model – This is probably the suggestion most will disagree with, because it is the furthest from the status quo. I’m not saying you should advocate for higher reimbursement rates or documentation standards. I’m saying stop allowing them to dictate your practice patterns. I see cash-based practice as the future image of physical therapy and I see that as a good thing. If you are afraid to take the leap completely, set-up a specialized cash-based service or program to supplement revenue.

Some challenges we face in 2013:

  • Direct Access – Before I am corrected and told that direct access is established in 90 percent of U.S. states, I am referring to true direct access. This implies recognition by third party payers, MDs and the general public. We have ways to go.
  • Practice Protection – Dry needling vs. acupuncturists, manipulation vs. chiropractors (I live in Washington State), and sport coverage vs. athletic trainers. Combine those with the general belittlement of our value as a health care specialist and the challenge is evident. In this case the best defense is a good offense. Be active and show your value, don’t rely on others to eventually realize it.
     physical therapy practice
  • Value Your Services – How do we expect others to value our services if we don’t instill enough faith in them ourselves? People will pay out-of-pocket for massagetherapy, acupuncture and chiropractic. They will do the same for physical therapy if they truly believe it will improve their pain, function or performance. This topic is worth revisiting in the future, but I will leave it with a simple question. Does your practice pattern reflect a value on your services? Are you maximizing quality of care, or maximizing patient volume?

To conclude, I extend my challenge to move forward with your physical therapy practice in 2013 and keep it's image in mind. If you own a clinic, have a meeting to set your own goals and implement new ideas or delayed inspirations. If you are working in a clinic, take a second to identify some personal goals or challenge the powers that be to take action. If you are a patient, challenge your physical therapist to provide the expertise you deserve.

As always, thank you for reading and we encourage your feedback. Discussion breeds education.

Follow me (@DPTwithNeedles) and my colleague (@DrAustinWoods) on Twitter to share more of your comments! You can also find us @DoctorsofPT and on Facebook.

About the Author: Dr. Paul Killoren is a member in both the American Physical Therapy Association (APTA) and the American Academy of Manual Physical Therapists (AAOMPT). He is also a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association (NSCA).

Click here for more articles by Paul Killoren, PT, DPT, CSCS.

Therapy professionals, if you enjoy writing or would like to share your expertise and are interested in becoming a PutMeBackTogether contributor, please click here.

Topics: Physical Therapy, Care Coordination, Will Hicklen, Therapy Software, Physical Therapy software, Accountable Care Organizations

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Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination. Ankota's primary focus is on Care Transitions for Reeadmisison avoidance and on management of Private Duty non-medical home care. To learn more, please visit or contact Ankota.

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