Outcome measurement is becoming standard procedure in therapy practices these days. It is being driven by therapists who want to measure and compare their outcomes to others and want to deliver better care to their patients. Policy makers are also fueling the fire, such as CMS with the FLR G Codes. CMS and payers are signaling a pivot from volume based to value based payment. Brief facts on this; BCBS is spending $65B on converting their systems to handle value based payment, and CMS has set a goal of tying 90% of all payments to quality and value.
What are we really talking about here? The new norm! Unless you have been practicing in some dark corner of the therapy universe, you are already capturing functional outcome. But hold on. Outcomes to one provider are not the same as outcomes to another provider. And outcomes to a therapy provider are not the same as outcomes to a payer. In Porter’s most recent paper; Standardizing Patient Outcomes Measurement, he points out the lack of standardization and the fact that “we’ve allowed “quality” to be defined as compliance with evidence-based practice [process] guidelines rather than as improvement in outcomes.” The physical therapy product we deliver is the change in functional status. As experts in movement, and movement as the basis of function, and functional status change as a true patient outcome; we are measuring the right thing, not just process compliance. What is lacking is standardization of outcome measures in physical therapy. That is another whole subject for another time, but as you read the rest of this, I will cast some comments towards standardization.
The most robust measurement system out there is FOTO. It has the largest database of episodes in the rehab space, >16.5M, and closing in on adding a million episodes each year. There are over 17,000 users in the US, Israel, and Canada. In over 3,600 clinics and hospitals.
Internally, you can compare one therapist to another, confident that it is an apples to apples comparison. Because of the 10 risk adjustment criteria (the most in the industry) one therapist can be compared to another. A manager has data to find out who is better at treating shoulders or knees. Plus, it gives an opportunity to mentor therapists who are struggling, so they can learn why another therapist may be doing better using FOTO with their patients.
We at TPI look upon FOTO as a patient engagement tool as well as an outcome measure. Seeing how the patient perceives their abilities, gives the therapist the opportunity to ask more questions to better understand what is really important to them; like, “What came to mind when you were asked about your ‘usual’ housework, school, and work activities?” Stating to the patient you truly care about the results they get from your therapy clinic as the reason you use FOTO helps to build that therapeutic alliance. The predictive feature of FOTO helps create the anticipation that the patient will improve and achieve their goals. The predictive feature makes clear to the patient what time they will need to invest in therapy in order to get to their goals. A more realistic picture at the start of therapy makes it more likely the patient will follow through with the proposed plan of care.
External to the therapist and whole practice, that same risk adjustment feature is used to make comparisons. Clinics can compare results with other clinics and practice to practice as well. This begins to truly make sense in value based contracts. There have been many meetings with payers where after a brief explanation of the scorecard features, they quickly understand FOTO can help them identify the higher quality providers. TPI uses its FOTO results in all payer meetings. Payers who really embrace the data we are showing them, move to value based pay. While not all payers are ready for change to value based pay, TPI has had success.
In a nutshell the important feature of FOTO is RISK ADJUSTMENT, at all levels, which is meaningful to the patient all the way up to the payer. TPI provides cloud based training on how to optimize your use of FOTO to achieve accurate and high level outcomes. You will find them at www.therapypartners.com in the Education Tools tab.