Playing the Long Game
CMS just proposed some of the biggest changes to Medicare payment in years — phasing out traditional MIPS, expanding who can play in the ACO sandbox, leaning harder into value-based care. None of it touches your DMEPOS fee schedule directly. Your reimbursement still runs the same way it always has: 80% of the lower of your charge or the allowed amount, per code, same as it's been for a long time.
So why should you care?
Because the physicians, surgeons, and care teams you work with every day are increasingly living in a world where their pay depends on outcomes and total cost of care, not just volume. MIPS Value Pathways bundle quality, cost, and improvement measures around a condition instead of scattering them across a specialty checklist. ACOs are getting bigger and more numerous under this proposal. Bundled payment models tied to joint replacement and other high-cost episodes are expanding too, with hospitals now on the hook for 90 days of post-discharge spending and quality scores that follow the patient well past discharge. Every one of those referral partners has a new reason to care whether their patients heal well, avoid readmission, and get back to function quickly. That's your world. You just haven't been getting credit for it in a way anyone can see.
I have said it before and I'll say it again here because it's worth repeating: pick one or two referral partners — an ACO, a joint replacement program, a busy ortho or vascular practice — and bring them a conversation, not a sales pitch. Show them what happens to their patients when your practice is involved early and consistently.
If you're already tracking outcomes, this part is straightforward. Pull your “before and after” functional scores, your follow-up-visit data, and your patient satisfaction scores. Layer that against the Dobson-DaVanzo research, which found Medicare beneficiaries who got timely orthotic or prosthetic care ran roughly $1,900 to $2,900 lower in total episode cost than similar patients who didn't get that care, and that prosthetic patients had comparable episode costs even after paying for the device itself. Put your numbers next to those numbers. Ask for fifteen minutes with whoever runs their care coordination or quality program. That's the whole first step. It costs you a conversation and a little prep time, nothing more.
But They Don’t pay Me For That!
Most of you reading this aren't tracking outcomes consistently. I know this because I hear it constantly, and the reason is almost always the same: "we don't get paid for this." It feels like extra paperwork with no payoff, so it slides to the bottom of the list every single time a busy day gets busy.
I've made this argument before and I'll keep making it because it keeps being true — outcomes data isn't overhead, it's three different jobs doing double duty:
It proves that the care you are providing really works, which is the whole case you're trying to make to referral partners in the first place.
It sharpens your own clinical decision making, because you can't tell if a protocol is working if you're not measuring what it produces.
It backs up your plan of care when a payer questions it and concretely demonstrates that the medical necessity you claimed to get paid was real.
With the changes already implemented in DMEPOS, you are going to need this data defensively. The referral conversation just gives you an offensive reason to start collecting it today instead of someday.
If You're Starting At Zero
You don't need a research department to start. Pick one outcome measure tied to one patient population you see a lot of; something like a validated mobility score for your lower-limb prosthetic patients, or a simple ABC or 5MWT for your drop foot patients. Track it at delivery and at one follow-up visit. That's it for phase one.
Do that for sixty days and you'll have something. Not a study, but something real and yours, something you gathered from your own patients that either backs up the Dobson-DaVanzo numbers or tells its own story. Either way, you walk into that referral conversation with your own evidence instead of borrowed evidence, and that lands differently with a surgeon or care coordinator who's trying to figure out who to trust with their next patient.
Where This Can and Can't Go
We all know that there's no current CMS mechanism where you bill Medicare more because a referring physician's quality score went up thanks to your care. That path doesn't exist yet. What can happen legally is a preferred-partner relationship — becoming the practice an ACO or bundle-holding hospital refers patients to because you make their numbers better. In some structured arrangements, there's room for care coordination compensation, but those arrangements sit inside specific value-based safe harbors under the Anti-Kickback Statute and Stark Law exceptions, and they have to be built carefully with legal counsel who knows that legal landscape. Don't build a business plan on a payment pathway that doesn't exist. Build a referral strategy on evidence that does.
That's the opportunity here. Not a new check from CMS, but a stronger seat at the table with the people who send you patients, backed by numbers instead of a handshake. This is how you can play the long game.