Welcome back to the Healing Pain Podcast with Alice Bell PT, DPT, Senior Payment Specialist APTA
In this episode, we are discussing an important reimbursement issue related to physical therapy, as well as pain care in general. That is value-based healthcare. Value-based healthcare is a healthcare delivery model in which providers, including hospitals, as well as practitioners, are paid based on the patient’s health outcome. This model differs from the traditional fee-for-service or a capitated approach in which providers are typically paid based on the amount of services they deliver. Joining me on this episode to discuss the trend of value-based healthcare, specifically in the physical therapy profession, is Dr. Alice Bell.
She earned her Doctorate in Physical Therapy Degree from the University of Montana. Now is on staff as a Senior Payment Specialist in the Public Affairs Unit of the American Physical Therapy Association. Her professional activities include serving as a member of the Centers for Medicare Technical Expert Panel for alternative payment systems, the CPT Editorial Panel, and is an APTA appointee to the NDHI Opioid Crisis Workgroup. She has been involved in bundled payment projects and exploring the alternative practice and payment model efforts focused on early and direct access to physical therapy.
In this episode, you will learn all about value-based healthcare, where value-based care intersects with the biopsychosocial approach to pain. Also, how physical therapists can assess their readiness for participating in an alternative payment model and how physical therapists can play a more central role in addressing pain in the US healthcare system. Without further ado, let’s begin and let’s learn about values-based healthcare with Dr. Alice Bell.
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The Pursuit Of Value-Based Care And Reimbursement With Alice Bell PT, DPT, Senior Payment Specialist APTA
Alice, thanks for joining in this episode.
It’s great to be here.
I’m excited to talk to you about this topic on the show. I have been very interested in this topic for a couple of years and I have been watching it grow. When I talked to my colleagues, some were very interested as well and some haven’t quite heard about it yet. This is an important episode, especially as we move forward looking at pain, lifestyle, and all the things that we are concerned about. We can be effective with regard to PT practice. Let’s start here, people hearing about values-based care. What is meant by value in healthcare? The word value oftentimes is thrown around. What does it mean in the context of this conversation?
It’s an important question and something we need to think about. We hear the traditional definition of value equals outcomes over cost and that’s what we hear over and over again. When you start to break that down and drill down to that, the reality is that the value is both stakeholder dependent and it’s relative. When we talk about outcomes specifically, what is important to the person with whom you are interacting? That’s different. What’s important to the patient versus what’s important to the payer, the legislator or the regulator is very different. Costs even can be a bit relative and stakeholder dependent in terms of, is it worth it? That’s different for different people in terms of the resources they have.
The other thing that’s important is when we look at relativity. It’s not, does what we do bring value. Is it worth something but is it worth more than something else? We have to justify in many ways that what we are doing is meaningful to the person who is engaged with us and that it’s equal to or better than something else that they could also get. One of the challenges because of that stakeholder dependency and relativity is that we are offering often having to balance what’s meaningful to a number of different stakeholders and those things are not always symbiotic. They are not always aligned. We have to think in terms of the context of our audience and that whole concept of relativity.
There’s a lot right there to open up, that one answer. The stakeholder you mentioned, there are multiple different stakeholders sometimes. The patient is a stakeholder, of course. That should be the priority but sometimes it isn’t necessarily always the priority. An employer could be the stakeholder. A private insurance company could be the stakeholder or a government payer could be the stakeholder. Did I get them all?
You probably did. Sometimes we can even think of legislators and stakeholders because we are often trying to get legislation passed that will address access to our services. That’s another stakeholder, that’s what’s important, their constituency. Are they going to make their constituency happy?
This is important when you think about things like the CAP and things like that. That has been going on since I have graduated from school, which is when I started, I remember it very clearly. You mentioned us as professionals, have to be able to prove that the service and the product that we are delivering, is a value and maybe even more valuable than another service. I’m using this as an example. I’m not saying it is or it isn’t but let’s say a patient is seeing a PT for chronic pain versus a patient seeing a psychologist for chronic pain. We have to begin to prove that in our case, PT is more effective or valuable in that case.
What’s important is that we have data that allows us to compare what happens with a patient who sees a PT first as compared to another provider. Now, sometimes we are comparing one provider against another. Sometimes we are comparing a set of providers against a single provider. In terms of behavioral health or psychology, that may be a model that is much more appropriate as a collaborative partnership with a PT, particularly to affect chronic pain.
Maybe you want to not so much compare the psychologist to the PT but you want to compare a psychologist and a PT to someone who sees a surgeon first or a primary care position first and what their trajectory or path is. That issue is important that we be able to look at not only what happens for patients who see PT but what’s happens for patients who see PT versus those who never get to see a PT or those who get to a PT so far downstream in their care that all the opportunity for cost savings was missed. Does that answer your question?
It does. The thing I think about most and I have talked about this on the show and discussed it with other professionals. I have a physician coming on and I’m going to interview him about the VA Stepped Care Model. What they started to do, like in that Stepped Care Model, was saying, “We have individual providers and a multidisciplinary pain center. When do we implement those things? When is it appropriate?”
If we send everyone to multidisciplinary care, that can be extremely expensive and the insurance companies have already sent us a signal that that’s not necessarily what the direction that they want to see a reimbursement go if you will. Providing value, as you mentioned. PT alone, or maybe a PT and a psychologist, is part of this.
That’s an important point because sometimes we get caught up in the best model and assume it applies to everybody. The reality is, first of all, it doesn’t apply to everyone. Second, we could never absorb the cost of giving this extravagant model to everyone. Why would we when it’s not aligned with what their needs are? We have to look at things in relationship to the goals and values of the patient, what’s important to them. What are they trying to achieve and what’s the most efficient path to achieving that?
I appreciate that because so often, people say, “The goal standard for chronic pain is multidisciplinary care.” My clinician mind kicks in, meaning, “Do we have enough clinicians in the world to provide that care?” No, we don’t. From a financial perspective, my brain kicks in, “Even if we did, that’s a very expensive care to deliver.” Let’s say we found the money. Do people want to go to either an inpatient or an outpatient multidisciplinary center for three months that takes hours out of their week? All those are factors in providing effective and efficient care. That’s the key, effective, efficient, and economical like the three Es.
Putting that in the context of the individual and what’s important to them and what they are willing to expend in terms of resources, whether it’s dollars, energy or time.
How did we arrive here at this place of value-based care where we are talking about this and excited yet, also trying to figure out, “What does this look like in the different circles we all function in?”
In part, we arrived here because of the unsustainability and the somewhat inferior performance of our fee-for-service model. What we know is what we have isn’t working and we know that there’s a path to something better but we are caught in this intersection between where we are and where we want to go. It’s a difficult transformation. Sometimes people think we arrived here because we are trying to cut costs.
We can’t afford it anymore, so we’ve got to cut dollars. That’s certainly part of it but there’s a whole bunch more. I like to think a little bit more about patient and provider flexibility as being one of the big objectives of this. We are so constrained by this CPT coding procedure and service environment that there are a lot of things that patients can benefit from that aren’t coded.
All those things that we know can help and that there’s some evidence around have to be absorbed by the provider, the patient or someone because they are not paid for through the traditional fee-for-service system. If they can’t be absorbed, they don’t happen, so people don’t get what could benefit them or what they need. Part of it is to move to this more flexible environment.
We are not so constrained by that fee-for-service definition and we can start to do what makes sense. What does this person need? We see doctors prescribing a healthy food plan for someone and an insurer paying for that in value-based payment. Something that never could or would happen under fee-for-service.
It’s that goal toward matching the needs of an individual going back to what’s going to be the most efficient and effective way to help them get them on better footing. Help them pursue a healthier life. It doesn’t dismiss the need for the traditional services and procedures that are defined by CPT but it doesn’t constrain us to only that.
In a value-based system or a value-based model, I know some of these have popped up around things like total joint replacements, for example. Instead of the PT Billing, TherEx, manual therapy, and therapeutic activities and so the physician billing, whatever they bill. We bring other providers in their all billing things. Is it that there’s one lump sum of money, we are providing care and there’s an essence, we are not ticking the box off on the CPT codes as much?
Here lies a little bit of the challenge. Bundled payments are like total comprehensive care for joint replacement are built on a foundation of fee-for-service. What was done to create those models is looking at historical claims data. All of the care that was traditionally provided to a patient how much that care costs and there were a discount laid over it because that was a targeted cost savings program.
The provider, whoever was considered the trigger of the episode. It’s often either the hospital or the surgeon who is triggering the episode, does get a lump sum of money. They are supposed to manage the care of that individual in the case of these bundles 90 days out. That includes the surgery and everything that happens thereafter. The problem is, first, it was built on a fee-for-service infrastructure.
It’s looking at cost based on what we have always done. Not what we potentially could be doing. Second, this CPT system is ingrained in us that even in these models, we are requiring people to still jot down the CPT and track what they did as if that is telling us everything we need to know. I consider those bundles to be this uncomfortable middle spot and they transition from fee-for-service to value-based. It’s like a hodgepodge of the old and the new, and we are trying to move but we are not getting there.
Ultimately, to get to true value-based care, we have to look at population health management. We have to look at taking a group of individuals and being able to restructure healthcare delivery around those individuals based on understanding the population and what they need, rather than these very targeted procedural areas and relying on old claims data.
It makes sense. In the example you gave, the physician or the hospital is the trigger. That makes sense because in a total joint placement a physician is performing the surgery and that provider is in charge of managing that sum of money. Is that correct?
That’s correct.
Does that mean because I think our colleagues are going to wonder this? If I’m in the town next to the hospital, I have a private practice. If I’m not part of the medical system or the hospital system, can I be part of that value-based care episode?
Yes, you can but, whether you will be given the opportunity is the question. What ends up happening in those models is that the triggering entity decides who their partners are going to be. There can be competing incentives. There are benefits to an integrated health system but there are also challenges to controlling the flow of patients to control expenditures and costs. That’s what we see.
The other issue is if you don’t look at quality outcomes and the cost, someone may dramatically cut costs do well but those patients a year later or six months later, back in the system for avoidable issues, problems or never achieve the quality of life that they might have achieved with a different trajectory of care. This movement to integrate both quality metrics and cost metrics is the ultimate end game.
It’s where we have to get because it goes back to that, is it worth it as compared to? You’ve also got to look at the outcomes as compared to. I spent less but six months later, that patient is in a skilled nursing facility because they fell or six months later, that patient’s not leaving their house because they never achieved functional community ambulation, whatever it might be. We are not necessarily projecting out far enough because many of these episodes are 90 days, as I said. We are also not gathering enough meaningful quality metrics to measure the impact of some of these cost savings strategies.
My mind is turning a little bit as we are talking. Again, our colleagues in the PT world and other professions, too, not only PT are also going to want to know, are physicians the only ones who can trigger this and manage the episode of care? Which means managing the money. Let’s say someone comes to a PT for chronic low back pain, which is a common daily occurrence in the PT world, as well as the chiropractic world.
I’m assuming that chronic low back pain is such an expenditure for the healthcare system. Eventually, someone is going to start to look at that if they haven’t already. Can we be the trigger for that value-based episode of care and can we manage it? Based on where we are heading in this country, at least and I do believe the globally as well. PTs are primary care providers of musculoskeletal pain.
We have an exciting opportunity that’s coming down the pipe. Historically, as you probably know, one of our challenges under MIPS reporting has been that we don’t have any cost and we have not been able to meet the certified health technology interoperability requirements. Now, under the measures development way for workgroup, there is the development of a low back pain cost measure. APTA is represented in that workgroup.
I sit on that workgroup as do to volunteer members. What’s exciting about this cost measure is that one of the triggering events could be a PT of value code. It will be the first cost measure that a PT could trigger the episode. That’s exciting. It’s the first opportunity we will have for that. We are hopeful that this cost measure may be available in 2023. It’s going through field testing starting in January of 2021.
PTs won’t be the only triggering event, so if the episode could be triggered by either an ENM code, so a physician visit. A PT of Val, an OT a Val or a chiropractic procedure code. The reason it’s a procedure code for chiropractic is they bill ENM codes but Medicare doesn’t recognize the code. We would have to use a procedure code but this will be the first opportunity to look at a condition, low back pain, and see the difference in cost between an event that’s triggered by a PT, versus a primary care physician versus a chiropractor.
We have some of that data already.
We have it in the United Healthcare Study and Tri-Care has some of that data but this would be a very large scale under MIPS or MBPs larger population. The challenge we had with UHC, even though the data is clearly convincing and indisputable, is that the end is relatively small for the number of patients that saw PT first. Even though we have the data from UHC, it wasn’t done as a formal cost measure for an episode model. Again, they went back retrospectively and looked at historical data. This would be a perspective going forward on what is happening with these patients.
Is this all driven by CMS, Center for Medicaid Services?
Yes.
Are we not necessarily talking about private insurance?
No, but it would give a framework that private insurers could also work under. When you look at developing the cost measures, you look at how long the episode is going to be? What is the reasonable time from triggering the event to the first intervention? What’s included and what’s excluded? Who are the primary populations and the subpopulations? How do you differentiate that data we didn’t necessarily get in UHC? All that drill-down detail. The opportunity to define that upfront gives us an interesting opportunity.
Personally, it excites me because as many of our peers can test to you, the CPT system is old and antiquated at this point. I think we have run it into the ground and it’s done. The time has come for something like this. I have always felt like, “Give me a lump sum of money. Allow me to manage it and I can make a decision as a licensed healthcare provider. How many visits they need, how much time they need.”
The other thing, which people are also going to ask questions about is, if I am the trigger as a PT for that chronic low back pain and they give me $1,800, let’s say. Now, it’s up to me to decide how many visits, how much time I want to spend with the patient, how much time the patient needs to have a positive impact. You alluded to this a little bit before. They are also going to track, “Are you doing TherEx, pain education, CBT or nutrition?” We are integrative professionals at this point. With that, we don’t quite have a CPT system that supports that. Might this be a better solution?
Yes, it might. In terms of what’s going to be tracked, that’s still to be determined. This is another one of those challenges in that transition to the value-based carrier, as we have cost measures, quality measures over here. We have improvement activities over here and how do we pull those all together because you could have different providers using the same cost measure but for different quality measures. The whole goal of MBP, which is the next generation of MIPS, is to get this all bundled together. It is a composite of specific quality measures, cost measures, and improvement activities so that we are comparing apples to apples. That’s the goal. We are not there yet.
Once we get there, you could say that your quality measures and your improvement activities in some ways replace your CPT code because they become the description of what it is you did and how you produced this outcome at this cost. It’s an evolution now. The reality is that the CPT system is baked into our existing model. There are a lot of stakeholders who have desires and motivations to continue to have that structure. It’s not that it serves absolutely no purpose. It serves a purpose, so we have to figure out what of that plays a role moving forward and how do you transform that system in a way that it’s meaningful because it’s a little less meaningful now.
My position and if you want to add to this or have anything to add to it, I tell PT specifically, we have this idea as professionals that we have PT-CPT codes, which we don’t. They are only CPT codes that anyone can use. A physician can use our codes. A physician can use what we would identify as traditional PT codes, so could in our team. Any licensed provider could. With that, we can bill other CPT codes as well. You may not necessarily get reimbursed for it and you may have to do a little bit of work to get reimbursed for something that’s not traditional like nutrition, let’s say, but it’s not outside the realm of what’s happening because it is happening.
It’s important that physical therapists recognize that the CPT manual is a very large manual and describes a lot of procedures and services that are not specific to certain disciplines. They are placed in sections of the manual because it’s more likely to be used by a certain group or a specific provider. There are some restrictions inherent in a specific code and things like practice apps, may limit the use of certain codes or payer policies. It’s not specific most of the time. We need to explore more because our charge as any provider is to select the code that most closely represents the care that we are providing. Not to try to retrofit our care into some short-list of codes that we are used to billing.
I do encourage people to expand their working knowledge of the codes that are available. We try through APTA to encourage people to think outside that 97,000 series set of codes. Also, to work with your stakeholders, whether it be payers or employers, and talk about why using these procedures may be appropriate and what you can demonstrate in terms of the effectiveness of those procedures when provided by a physical therapist and try to push the envelope a little bit. Unless we push our boundaries getting tighter. Everybody is trying to restrict. We have to be looking to expand.
To everyone reading this show, is pushing the boundaries. The two codes I encourage, particularly the people who follow this show, to explore behavioral health codes because they fit well with pain education, mindfulness, with CBT-based techniques. Those are not codes that are only for mental health providers. We as PTs, are making significant behavioral changes. There’s the time involved in that and the other is nutrition, which is now part of our scope. I appreciate you saying, “Push outside the boundaries.”
This is for the people reading. The one challenge I find, what happens is, a PT will conduct a traditional PT evaluation, which is typically strength, the major emotion function, things like that. Four weeks down the line, they will throw in a behavioral health code or they will throw in a nutrition code and it gets denied. They say, “This is not reimbursable.” I always say, “Go back to your evaluation. Look at your evaluation. Did you have some self-report measure that’s related to either nutrition or behavioral health?” Those are out there readily available and easy to use. “Did you include that in the plan of care?”
If you did include it in the plan of care and you didn’t do it in your evaluation, then, of course, they are going to throw it back to you and deny it. It’s not difficult. We have to be thoughtful at the time of the initial assessment to set up the person reimbursing the care, as well as the patient to know that, “We may not talk about this on the first session but we are going to be discussing many different components of your care.”
It goes back to that whole concept of whole-person care. Looking at everything that’s contributing to the reason that individual ended up on our doorstep and everything that we have, the potential to influence based on our knowledge, our skillset, and our scope of practice. Being as comprehensive as we can in that initial examination of the patient using all of the tests, measures, patient-reported outcomes, patient interviews, and techniques that are going to get us to the root of what we can and should be addressing.
At the same time, understanding that their policy may constrain the use of some things and we may have to fight a little harder and do some additional advocacy or look at our specific contract with a payer that may be unique based on the types of services we provide as compared to other providers. The onus is on the provider to define and defend what it is they are offering in terms of the scope of care that they can provide to a patient.
As a healthcare professional who is interested in providing effective, as you mentioned, whole-person biopsychosocial pain care, as well as biopsychosocial care at this point. Everything should be biopsychosocial. Should we be excited about values-based care supporting that endeavor and will it help with more effective care going forward for chronic pain specifically?
The answer is yes if we achieve the objectives that we intend to achieve in this transition. The goal is to get to a place where providers are more focused on the broad needs of an individual, recognizing the importance of prevention. Also, the importance of patient engagement in their self-management, and understanding what is the quickest, least resistant path to the best end for that individual. It should take us there. We still have a lot of obstacles to overcome and a lot of areas within the existing system that needs to be challenged to get there. I do think there’s a great opportunity.
We hit a little bit of a roadblock with COVID and I don’t mean COVID is little. It has thrown a roadblock in this transition for a lot of reasons, delayed care, inability to access care. We have taken in some cases, twelve steps backward on some advances that we are making. People are trying to regain their footing from everything that happened. We are going to have to get the train back on track again.
If we keep focused on the fact that our goal is patient-provider flexibility, whole-person care, practicing at the top of our license, offering the full scope of what it is we can do but we are going to have to have data. We have to have data, gathering meaningful information at that first interaction with the patient. We’ve got to be able to capture it at points across the episode of care, measure the impact at the end of care, be able to speak to what it took to get there, understand the cost of the care we provide. All of those things are important.
As you mentioned, COVID brings in a different flavor, which we weren’t anticipating. It impacts all our efforts, I would say. Like many things, there are some silver linings. Like Telehealth came out of that, which has been important. You work within the APTA and we thank you for your service to the association and our profession.
You mentioned the word barrier. I’m curious, not from a values-based perspective but from where you are sitting and your experience both as a clinician and you have done some research. Now you are working more from inside the association. What do you think is the one biggest barrier that we have as physical therapists for moving our profession forward to where we should be as licensed doctoral leading health professionals in the United States?
To come up with a single barrier is difficult. Certainly, one of the most significant barriers is where we are positioned in the healthcare system. In most settings and models, we are not that first line of defense that frontline point of access, which is so important for many conditions because there are windows of opportunity with patients to impact downstream cost, impact meaningful outcomes, when patients don’t get to us until 2, 3, 4 or 5 weeks in the course of their condition, that delays often insurmountable.
When you say our position, I want to clarify because there are lots of different ways to define that but what you mean on some level and correct me if I’m quoting you wrong, we are in some way still looked at as allied health providers where we need to be in that primary health provider role.
Correct. It’s the point of contact if you think. Can we be the first point of contact? Yes, the primary healthcare provider is probably a good term. We are constrained by a number of different things, whether it be care policy, Medicare regulations, state regulations, and simply consumer awareness. There are a lot of things that create that barrier. We have to take all those things on.
One of the big things is that whole consumer awareness piece, which is why to Choose PT has become such a broader consumer awareness campaign to let people know that we are here and you can access us first because there are a lot of situations under which patients can access us first. They are not fully being leveraged yet. That’s one thing.
I would say the second barrier is sometimes one of our own in terms of making sure that, as providers, we are embracing the evidence-based practice that we are current on effective interventions for low back pain, for example. Looking at things like active versus passive interventions and how important that is. Although, there are some arguments to be made that variability in practice is not as important because when you look at the data like from UHC, we don’t know other than the difference between active and passive. We don’t know what treatments those patients received specifically but we know no matter what, if they saw PT first, the cost was lower.
At that highest level, you could say it doesn’t matter as long they see a PT first but it does matter when you start to drill down. If the numbers were larger and we could compare intervention to intervention, we, as a profession, have to make sure that we are doing what we need to do to be as current as possible and that we are gathering meaningful data. We are still not there with every PT gathering useful data.
You talked about it in the beginning, what’ an evaluation? What falls into an examination? If you look at the guide to PT practice, it’s a lot more than a range of motion, strength and function. We need to look at the full depth and breadth of what we need to be gathering. We need to extrapolate out from a whole that data, what’s most meaningful, and what we need to drill down and measure around. Make sure that we are not doing it at the start of care but throughout care and at the end of care.
We are considering patient-reported measures because that’s important as well. We may say, “How wonderful we did.” They are doing all these things better but if at the end of the day, the patient isn’t where they intended to get and we haven’t gotten to a place where we fully understood their expectations and are able to deliver on them. That’s a real problem. I say the patient could be the employer as the stakeholder. It could be the payer as the stakeholder.
There are opportunities here for PTs to start to look at what’s happening, to follow what’s happening within this whole concept, both on the CMS level and private payers because some private payers have started to dip their toe into this area. It’s a place where PTs can start to step up and say, “I can be the one to manage this, especially within the realm of certain lifestyle-related chronic pain conditions, which are so prevalent both in the private sector, as well as the public sector.” You did an excellent job of drilling down to some of the details about this in this episode.
Hopefully, people are interested in watching this unfold and become involved in all the different ways we can be to become involved to support this. I do think values-based care will continue and it’s important, especially in the world of pain care. If people want to continue to follow this topic and the work you are doing supporting this topic, how can they do that?
Please, first go to the APTA website and get engaged with all of the information and the resources that are available to you. Also, if you have questions, issues or concerns, you can email us at [email protected] and someone from the APTA team will get back to you and support you in those efforts. Be an engaged member, get involved, look at the opportunities for advocacy, and please take part in them. The more voices, the better our opportunities are for positive change.
Also, get involved at a local level. Look at places where PT can be represented on local workgroups, boards or communities. We saw that a lot with the opioid epidemic. There were a lot of these local councils developed and PTs who sought to get involved were able to be on these councils and influenced the direction particularly in Medicaid programs and other state-based programs of where funding would go and what would be considered. Be engaged, be involved, and please avail yourself of the resources that APTA has put together.
Everyone knows the website. It’s APTA.org. If you want to reach out to Alice or the members of the American Physical Therapy Association and see how you can become involved or gather some more data on this important topic of value-based care, that’s there for you. I want to thank Alice and everyone at the APTA for helping support this mission and for joining us to discuss this topic. Make sure to share this with your colleagues and the PT profession around the globe. This is an important global issue but other colleagues, friends, and family might be interested as well.
Do you have overlays with political issues that all of us are interested in with effective and affordable healthcare? Make sure to share this with your friends and family on Facebook, LinkedIn, Twitter, Instagram, wherever anyone is talking about value-based care. Once again, I want to thank Alice for being here. I’m Dr. Joe Tatta and we will see you on the next episode.
Thanks so much, Joe.
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About Alice Bell
Alice Bell, PT, DPT, is on staff as a senior payment specialist in the Public Affairs Unit of the American Physical Therapy Association. Alice received a bachelor’s degree in physical therapy from Northeastern University in Boston, MA and a doctor of physical therapy degree from the University of Montana. A board-certified clinical specialist in geriatric physical therapy, she has lectured and written many articles on topics related to physical therapy and the older adult. She has practiced in a variety of settings and has 38 years of experience as a physical therapist. Dr. Bell has presented at many national conferences. Her professional activities include serving as a member of the Centers for Medicare and Medicaid Services Technical Expert Panel for Skilled Nursing Alternative Payment Systems, APTA staff representative for the CPT Editorial Panel, APTA appointee to the NDHI Opioid Crisis Workgroup and the National Quality Partnership Opioid Stewardship Action Team, member of the National Quality Partnership Leadership Consortium, and APTA representative to the National Quality Forum Measure Applications Partnership. Dr. Bell has been involved in bundled payment demonstration projects and exploring alternative practice and payment model efforts focused on early and direct access to physical therapy.
