Business
How RVUs (Not the Conversion Factor) Quietly Squeeze PT and OT and the Practical Blueprint to Shift From "Minutes" to ACO-Ready Value
(read the full transcript here)
In this episode, Alex and Dana discuss the CMMI ACCESS Model and what it could unlock for MSK care inside ACOs. They debate digital enablement reality and explain how aligned incentives can reshape referral pathways. They make a direct case the that the physical therapy profession's future depends on understanding payment mechanics.
A core theme of this episode is that if PT stays positioned as specialty care based on "treatment minutes" as the primary service, it will keep losing in a system shifting relative value units (RVUs) toward primary care and behavioral health. If PT repositions around evaluation-driven expertise and ACO partnership, the profession can move from survival to influence.
Here's what else you'll learn:
- Why the ACCESS Model payments are intentionally low, and why that is not the point.
- How ACOs think about total cost of care and why MSK spend is hard for primary care to manage.
- What “aligned incentives” can look like in a PCP + ACO + ACCESS org + PT partnership.
- Why engagement is often 3–5% for digital MSK programs, and what that means in context.
- A practical “go do this tomorrow” play for clinics: identify local ACO participants and pursue Preferred Provider relationships.
- The RVU basics most therapists never learned, and why it changes your advocacy strategy.
- Why PTs should prioritize evaluation, differential diagnosis, and plan-setting, with PTAs executing more follow-up care.
- How waitlists and access challenges become non-starters if PT wants to play in ACO-aligned care.
- A potential new productivity mindset: RVU-based expectations instead of “visits per week.”
Want more information on PT and OT reimbursement and opportunities in policy and advocacy?
Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid."
Follow Dana Strauss on Linked In.
Follow Alex Bendersky on Linked In.
Subscribe to the Future Proof PT Linked In page.
Subscribe to the Future Proof PT YouTube Channel.
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