**Disclaimer: All opinions and ideas expressed in this article are solely mine and none represent a recommendation or should be viewed as advisement of any kind to anyone to do anything.*

If you are a treating clinician or provide team-based clinical support in primary care, physical therapy, or behavioral health, here’s what you should read between the lines before the model even starts. You have preparing to do!

There so much content online about how ACCESS works and opinions about the model. Before coming to any conclusions, consider doing these two things:

As you may have read, clinicians billing the physician fee schedule for a patient population can’t be ACCESS organizations unless they want to stop billing fee-for-service codes. Given the very low reimbursement ($180-$420 per year maximum, depending on outcomes, substitute spend, and ACCESS Track), that is highly unlikely.

CMS established codes for which they consider ACCESS codes to be a substitute. For Tracks 1 and 2, these are a host of care management codes and remote monitoring. The full lists per Track are in the CMS documents.

For the sake of example, let’s look at Track 3, Musculoskeletal Care. The ACCESS code substitutes for PT Evaluation, OT Evaluation, and Remote Therapeutic Monitoring Set Up. These are three non-time-based codes, and all therapy episodes begin with the evaluations, of course.

If a patient is receiving care from an ACCESS organization and seeks a PT or OT evaluation for the same condition, the ACCESS organization will earn less than their full reimbursement because of the “substitute spend” rule. We can only speculate whether patients will be less likely to seek therapy while receiving the digital health care of the ACCESS organization.

For patients who do not receive both the ACCESS services and a PT or OT evaluation, CMS will be able to compare the costs over any longitudinal period between the ACCESS organization and the PT or OT services. They can look for any differences in spend across a longitudinal time period to observe differences in care trajectories.

Does one path or the other, for a similar patient, correlate with lower ED utilization? Lower use of advanced imaging? Lower use of specialty medical visits? Lower use of injections or surgical procedures? CMS will be able to answer these questions as the model progresses.

Are you prepared for CMS to compare the ACCESS org patient trajectory to the traditional care trajectory and the results?

Then let’s look at the outcomes measures CMS is using to determine whether the ACCESS organization providing care for Musculoskeletal conditions has earned their full reimbursement. They focus on patient reported outcomes measures in the MSK Track.

With this information, CMS can analyze spend and the outcomes achieved subsequent to that spend. CMS doesn’t presently have all of this information from OT or PT episodes of care.

I would argue this makes the Outcome Aligned Payment measures the new gold standard for demonstrating value in rehabilitation episodes starting in 2026.

Interestingly, these are not the same measures as are offered in the MIPS Value Pathway (MVP) “Rehabilitation Support for Musculoskeletal Care.”

However, if I was a clinical owner or operator, or an owner or operator in behavioral health or primary care related to the other ACCESS Model Tracks, I would be collecting the OAP measures for your patients starting in July. Even if CMS doesn’t require them, it’s valuable information. Know in real time if you are meeting the targets set for ACCESS organizations.

And it has a name.

The good news and the punchline? It’s plastic. You can improve on it.

It can be grown by aligning your daily actions with a north star goal that excites you.

So what is this crucial ingredient to the recipe of success?

Grit.

Watch Angela Duckworth’s famous, brief, Ted Talk on Grit that has 17 million You Tube videos 👇

What does it look like to be gritty in the game of career growth?

Clinicians who successfully transition into non-clinical roles and/or leadership positions keep trying when others give up.

They aren’t necessarily the ones who start with good networks, perfect resumes, or have the clearest plan.

Because transitions of any kind are hard. They don’t have a perfect roadmap. Many people quit.

The good news? Grit is a skill. It’s not a personality trait like you might think.

It’s staying the course towards a new life because you want to.

Think about it.

If a patient doesn’t respond to the first treatment, you don’t quit caring for them. You iterate, research, and try the next thing.

Career grit is similar. It’s about getting out of your comfort zone, practicing, and developing rituals that will keep you on track regardless of how you feel on a given day. Consistency is key.

If you’re thinking “but I’m not a gritty person,” STOP. You made it through advanced education that has a built-in attrition rate. You have worked in some of the most physically and emotionally demanding professional roles. You often have incomplete information when you are evaluating a patient and yet you make it work.

We are often conditioned to believe having perseverance in clinical settings as “just doing our jobs,” while viewing the same behavior in career transitions as some special trait that others have.

You objectively can sustain effort towards difficult goals. Give yourself permission to apply that same persistence to your own ambitions instead of towards achieving your license or helping patients achieve their goals.

The perseverance you have been using was already there! In clinical training and roles, you directed it where you needed to because that’s what your training demanded and what felt legitimate.

You justify endless persistence for clinical work but perhaps feel that dreaded “imposter syndrome” in applying the same tenacity to your own ambitions.

“Success” in this journey is about redirecting the grit you already have. You are strategically building your future.

Inspired by Angela Duckworth, here’s a framework to apply to your career transitions and growth strategy:

Write down your ultimate concern. Do you want more autonomy? Systemic Impact? Financial Freedom? “Better hours” won’t keep you going in the face of rejection, but something like “changing how one million people access primary care” will.

Clinician often fear mistakes. Fear of law suits, patient harm, reputational harm, etc. However, in the corporate world, mistakes = data.

“Practice” your transition. Send the cold Linked In message (but not with an “ask,” of course 😃 ). Apply for a job you aren’t too excited about just for the chance to experience the interview.

Build grit by being immune to the sting of being told “no.”

It’s easier to become more gritty when you automate the practice.

Create a non-clinical hour two or three days a week.

Maybe it’s after the kids are in bed, 8-9 PM Tuesdays and Thursdays, or before the house is awake, 6-7 AM. Maybe you skip happy hour on Fridays with the clinical team.

During these hours, you are a career architect. You research, learn, comment on Linked In posts to expand your reach, read a book chapter, or upskill.

(Whatever you do during your career architect hours, make sure you make notes in your personal knowledge management tool, of course!)

I created this to help you audit your transition. It’s purpose? Help you stop guessing and start measuring the three pillars of a successful move: The North Star, Low Stakes Failure, and The Boring Habit.

Here’s how to use it:

*Disclaimer: All opinions and ideas expressed in this article are solely mine and none represent a recommendation or should be viewed as advisement of any kind to anyone to do anything.*