CMS ACCESS pays PT practices $100 per patient per year to longitudinally manage chronic MSK — decoupled from visit volume. JointCoach provides the RTM data layer, PROM engine, and physician-attested compliance infrastructure to get your practice enrolled and generating revenue from Day 1.
ACCESS is not just an OAP check. For PT practices using JointCoach, the full revenue architecture spans pre-ACCESS RTM, the ACCESS co-management fee, and post-ACCESS RTM resumption.
JointCoach RTM (CPT 98985 + 98979) runs 1–3 months pre-enrollment. Establishes digital literacy and collects baseline PROMs. Revenue continues during this phase.
RTM ActiveYour practice earns $100/pt/yr as the co-managing clinician. Monthly digital check-ins (~3×/year review, no extra visits required). RTM billing pauses to avoid Substitute Spend penalty.
Core RevenueAfter the 12-month ACCESS period, RTM billing resumes at full rate (~$1,260/yr/pt via CPT 98977 + 98980). Patients remain on JointCoach. Revenue scales with panel size.
RTM ResumesEvery PT practice is different. Practices inside ACO networks follow a different on-ramp than post-discharge orthopedic practices. JointCoach supports both.
Your ACO or PCP partner identifies beneficiaries with chronic MSK via claims analysis or HIE queries. Chronic MSK pain > 3 months required.
PT performs initial functional evaluation under FFS. Confirms eligibility and biopsychosocial complexity. Low-complexity patients route digital-first.
Enroll patients into ACCESS via JointCoach. Monthly digital PROM check-ins. PT remains clinical hub for triage and care decisions throughout the 12-month period.
Deliver standard in-person care for the presenting complaint. JointCoach RTM runs in parallel during the FFS episode — building baseline data and digital habits.
Flag patients with chronic MSK near discharge — those likely to remain symptomatic or benefit from longitudinal support. JointCoach surfaces PROM trends to guide triage.
Enroll for 12-month longitudinal support and outcome tracking. RTM pauses during ACCESS to avoid Substitute Spend penalty — resumes at full rate post-program.
CMS ACCESS requires audit-ready PROM collection at baseline, quarterly, and end-of-period. JointCoach auto-collects every instrument on schedule — no staff follow-up required.
| Category | Instrument | Indication | Success Threshold | Collection Schedule |
|---|---|---|---|---|
| Generic | PROMIS Physical Function 6b/CAT | All MSK | ↑ 2-pt T-score | BQE |
| PROMIS Pain Interference 6a/CAT | All MSK | ↑ 2-pt T-score | BQE |
|
| Site-Specific | KOOS JR | Knee | ↑ 10 pts | BQE |
| HOOS JR | Hip | ↑ 10 pts | BQE |
|
| Oswestry (ODI) | Back | ↓ 8 pts | BQE |
|
| Neck Disability Index (NDI) | Neck | ↓ 8 pts | BQE |
|
| QuickDASH | Shoulder/Arm | ↓ 10 pts | BQE |
|
| Pain | NRS 0–10 | All MSK | ≤ 2-pt increase | BQE |
| Global | PGIC | All MSK | Qualitative anchor | E |
B Baseline (Day 0–60) · Q Quarterly (Month 3, 6, 9) · E End-of-Period (Day 425 + PGIC) · Goal: ≥50% of enrolled patients meeting improvement threshold (OAT).
MSOs, PE-backed groups, and practices with complex ownership structures: the affiliation and substitute spend rules are the most consequential part of ACCESS. Read them before you structure any partnership.
For large PT groups or MSO-backed practices: if your management company or PE sponsor owns ≥5% of the ACCESS entity you create, your entire PT practice loses FFS billing capability for those patients. Structure carefully.
Complete transition to ACCESS for that patient population. Embrace FFS exclusion as a feature, not a bug.
Structure partnership via service contracts, not equity. Keep cross-ownership below 5% to maintain FFS billing for non-enrolled patients.
JointCoach's RTM billing intentionally pauses during the 12-month ACCESS period to keep your SST below 10%. This is not an accident — it's the sequencing that protects your reconciliation payment. Pre- and post-ACCESS RTM remains fully billable.
Hinge Health and Sword are B2B employer plays. RevelAI and Limber are PT tools. Neither captures downstream surgical revenue or closes the surgeon ↔ patient ↔ PT loop. JointCoach does.
JointCoach guides your practice through every step — from Cohort 2 application through first patient onboarded and first PROM collected.
Program goes live July 5, 2026. Cohort 2 accepts quarterly rolling admissions. Tell us about your practice and we'll walk through whether JointCoach is the right fit — and what your enrollment and revenue timeline looks like.