Added Value

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Use technology to improve your bottom line while putting your patients first.

By Quinn Worden

You likely started your practice for more professional autonomy, a passion to deliver better care to the communities you wanted to influence, or perhaps financial independence for your family. The value you create is what matters, but it’s up to each of us to define what’s most valuable as a private practice owner.

As the son of a physical therapy private practice owner, I grew up watching my father enjoy the rewarding aspects of ownership. I would hear about the success stories of getting that high school senior back on the field to play team sports, or the 80-year-old weightlifter who wanted to get back to competition, and did. I heard about countless other patients whose lives were improved after treatment by my father and his team. Sitting around the dinner table I also got to hear some of the not so fun conversations: discussions about increased costs, decreased payments, and the struggle to keep it all together while pursuing my father’s dream of owning a private practice. It would be ideal if there were a way for business owners like my father to leverage technology to help patient outcomes and better control costs.

In a time of growing costs and decreased payment, wouldn’t it be nice to find other revenue streams to supplement your practice? Did you know there are companies out there that offer technology-enabled solutions to control costs and improve your bottom line with a focus on your patients’ outcomes? Most practices need to dispense some type of physical therapy products or at least make recommendations on where to buy specific items. Imagine the ability to sell products and supplies that your patients need, that you recommend, while you build additional value for your practice. There are numberous variations of online health stores, virtual showrooms, and e-dispensaries for your practice. Depending on your needs, some may be a great fit. Even if you are doing a minimal amount of dispensing physical therapy products, having your own supply line could help to keep your patients and referral sources achieving optimal outcomes. Patients will appreciate the convenience of purchasing helpful products right in the clinic, with demonstrations and advice from their physical therapist and feedback at the next appointment.

I’m not suggesting that your team suddenly becomes a bunch of predatory product peddlers, convincing patients that they need dozens of products to improve their outcomes while you fixate on your bottom line. Simply adding technology to streamline patient care improves business performance and enhances patient outcomes. The fact is, your patients do have a need for products, and offering these products puts your patients first. Sure, your patients can use a bag of peas, but does icing with an elasto-gel ice pack provide a better outcome? I argue, absolutely!

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You know your practice, you know your patient populations, and you know the supplies that you are already recommending to them. Right now, you might be sending them to the supply company down the street, guiding them to Amazon, or sending them to local big name pharmacy chains. Why not use technology to your advantage and help your patients at the same time? Patients would be pleased to be able to buy products right there in the clinic, rather than adding a separate trip or online search to their to do list.

It’s time to stop cutting off pieces of resistance bands and giving them away to your patients. It’s time to consider having your own in-clinic retail program, and with today’s technology it’s easier than ever. Imagine being able to supply, and easily track, commonly used items like ice packs, foam rollers, stretch-out straps, shoulder pulleys, and much more directly on site. Simply find the technology that works for you, open an account, select your inventory, and you’re in business! Look at the number of unique patients who come through your doors. How much product do you think that patient population would truly benefit from? This should give you an idea of the potential income opportunity by identifying a value add system to better serve your patients.

As a private practice owner you’re not a high-volume retailer, but you are a highly educated clinician who wants to help your patients while maintaining your bottom line. Finding an in-clinic retail solution could be a great addition to your practice. Having a solution that will allow you to effectively track your inventory, apply sales tax where applicable, and process your payments easily could ultimately improve your business performance.

Discovering these technologies will improve your bottom line, but more importantly improve your patients’ outcomes. By not giving away resistance bands and finding technology-enabled products to improve your bottom line, you’ll be creating more value for your patients, your team, and yourself. Your time with your patients as a health care professional is valuable, and so taking the time to educate your patients is valuable. Look at the big picture: The next time you or your team reaches into your drawer for the scissors to cut yet another couple pieces of resistance band to give away will likely cost you 15 percent or more of what you’ll collect for that visit. Take action to improve your bottom line, add value to your practice, and support your patients by providing them with helpful products for a speedier and better outcome.

Quinn Worden is the president and founder of PTUnited, a company that uses the power of the internet and leverages technology to deliver more efficient supply chains. He can be reached at qw@ptunited.com.

Podcasting for Patients

Podcast

A step-by-step guide to marketing directly to the public.

By Jarod Carter, PT, DPT, MTC

In today’s competitive physical therapy market, generating patient referrals can be a daunting task. Gone are the days of relying on the local physician for new patients, especially given the emergence of physician- and hospital-owned physical therapy services (POPTS, HOPTS) and large therapy chains.

Tracking for Success

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Why outcome measures are essential to your practice.

By Heidi Jannenga, PT, DPT, ATC/L

Physical therapists have long operated in a system of restriction, and in some cases, that’s a good thing—after all, this is a profession that thrives on treating and healing patients within the confines of evidence-based practice. But in many ways the traditional system is broken—and that’s growing more apparent as the US health care system shifts to an environment of value-driven payment and care delivery.

While change often doesn’t come easy, this shift, along with Direct Access, actually presents a major opportunity for physical therapists to break free of their misguided reputation as “adjunct providers” bound by physician orders, and instead:

  • make their value known,
  • secure their rightful place as primary care coordinators in the health care continuum, and
  • ensure the future success of their practices.
But in order to thrive in the evolving health care environment, physical therapists also must break free of passive evidence-based practice and instead embrace active evidence-based practice. So, what does active evidence-based practice look like? It means:
  • Staying up to date on the latest research in your areas of practice
  • Regularly attending continuing education and training courses
  • Learning about new, well-researched approaches to evaluation and treatment
  • Adopting those approaches—and tracking and analyzing the results
  • Adjusting treatment protocols accordingly

We’ve traditionally been great about upholding those first three bullets, but the last two are what makes our care truly evidence based. They’re also what will set your practice up for success—both today and for many tomorrows to come.

Measuring to achieve mastery

By measuring the results of new or recently adopted best practices, treatment methods, or care approaches—even the ones that are already well researched—we can assess the actual impact of those changes in our specific clinics. That way, we have a more accurate—and data-backed—view of what’s working and what’s not, and we can better pivot and improve from there.

Of course, data collection in the context of payment reform is important—by now, we’ve all heard that we will need data to survive the transition to a pay-for-performance reimbursement methodology—but we can’t forget about the value of outcomes tracking in the context of patient care. To realize that value, we have to apply the information we collect in a meaningful way. This goes beyond merely tracking numbers and figures. It requires processing and analyzing that data in a manner that allows us to take informed action. Otherwise, what’s the point?

The argument against outcomes tracking has long been: “Data collection takes time—time that we don’t have.” Today, however, innovative, intelligent software has taken over a process that used to require recording data with a pen and pad, plugging it into an Excel spreadsheet, and then going back later to figure out how to make heads or tails of it. We now have access to outcomes-tracking software that does the analysis work for us—all without having to reenter information that’s already been collected (if said outcomes software integrates directly with your electronic medical record [EMR], that is). This data is a powerful tool: It enables you to create intelligent reports organized by diagnosis, therapist, clinic location, or any other variable you can think of—and then easily measure the success of the practices you’re implementing.

Internally, this raises the level of accountability for treatment decisions and care quality. Furthermore, it also empowers therapists to make better, more informed clinical decisions in the future. Through this process of data collection and analysis, we close the loop on the research; we work through the entire scientific method, which makes our practice truly evidence based.

Refocusing the lens on quality

Now, back to payment reform: As part of the reform-driven overhaul of the US health care system, the volume-based payment systems providers have grown accustomed to are quickly moving toward extinction. That means that, sooner rather than later, providers in all disciplines—physical therapy included—will be paid based on a pay-for-performance, rather than fee-for-service, payment structure.

And that transition is moving fast. Just last year, the US Department of Health and Human Services (HHS) announced its goal to:

  • Base 30 percent of all Medicare fee-for-service reimbursements on alternative payment models by the end of 2016
  • Increase that proportion to 50 percent by 2018
  • Link 85 percent of fee-for-service payments to outcome measures by the end of 2016
  • Bump that percentage to 90 percent by the end of 2018

That’s quite an aggressive timeline—and it’s one the government is already making massive headway on. In fact, CMS (Centers for Medicare & Medicaid Services) has already passed that first 30 percent threshold—way ahead of schedule.1 Never before have we seen a government-led push for such a radical health care payment overhaul in such a short amount of time—with defined deadlines, to boot. And as history has taught us time and time again, it’s only a matter of time before the private health sector follows the government’s payment policy lead. In fact, some private insurers and provider groups have already jumped on the alternative payment model bandwagon.

But again, this change is a good thing. That’s because, under the incumbent fee-for-service payment structure, providers must do one of three things to increase practice revenue:

  1. take on more patients,
  2. bill for more services, or
  3. bill for more expensive services.

None of those fall in line with active evidence-based practice. But in the new pay-for-performance paradigm, we have an opportunity to operate within a practice model that’s far better aligned with who we are as providers—one that values quality over quantity.

And to ensure your practice’s success in that paradigm, you absolutely must be able to prove your value. So, in addition to embracing the mindset that our value is defined by our unique expertise and abilities as providers, we must begin to measure the quality of care we provide patients. This really goes hand in hand with the concept of active evidence-based practice. After all, you can’t focus on providing quality care unless you measure the quality of the care you’re providing.

Reference

1. http://www.hhs.gov/about/news/2016/03/03/hhs-reaches-goal-tying-30-percent-medicare-payments-quality-ahead-schedule.html. Accessed November 2016.

Heidi Jannenga, PT, DPT, ATC/L, is the cofounder and president of WebPT. She can be reached at hjannenga@webpt.com.

A Better Outcome

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Using outcomes to help improve your bottom line.

By Al Amato, PT, MBA

Rehabilitation providers continually struggle to make ends meet. They are required to collect outcomes data to satisfy Centers for Medicare & Medicaid (CMS) reporting requirements for Functional Limitation Reporting and Physician Quality Reporting System, and other payer reporting demands. At first, this requirement seemed to be another cost with little benefit to the provider. Now providers are using outcomes reports to track patient progress in addition to fulfilling mandated reporting requirements. Using outcomes in daily practice has become a necessity for payment and a boon to improving patient management with patient-reported data.

Besides using patient-reported outcomes for compliance and to measure patient functional change, this information can be repurposed to help improve your bottom line. Outcomes data collection processes used this way can be thought of as an investment that produces a return for work you have already done. How you collect, organize, and store outcomes data results in direct costs in staff time and other facility resources, or you may opt to purchase an outcome management system. The question is: How do I turn that cost into an income-producing opportunity, and therefore make the outcomes management process pay for itself?

As a manager of a rehab facility one of your priorities is staff productivity: You want to fill all scheduling slots, have a steady stream of referrals, a referral base, and to expand the number of referrers to your facility. You want to turn each patient into a practice promoter, and you want information to use for negotiating with payers. Using outcomes data—packaged in the appropriate way to address each need or audience important to your facility—will enhance your bottom line and therefore become a positive return on investment (ROI).

In order to repackage outcomes data into marketing materials, you need to take a few steps. First, staff productivity is dependent on enough referrals to the facility so managing the no show/cancellation rate is critical to maintaining high productivity. The industry standard for a no show/cancellation rate is about 15 percent. If each visit represents about $80 in revenue, each incremental decrease in the percentage of your no show/cancellation rate means increased revenue.

My experience using an outcomes report as a patient communication/engagement tool to help set patient expectations for number of visits and expected functional change resulted in an improved no show/cancellation rate from 11 to 6 percent. This easily paid for my staff time and expense for the outcomes measurement system used in my clinic. Continued use of the outcomes status (interim) reports reinforced good patient communication and resulted in nearly 100 percent patient satisfaction. This turned patients into practice promoters, which resulted in increased word-of-mouth referrals to our practice.

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Organizing specific physician marketing reports, either with increased staff time and effort or using an outcomes system that produces such reports made marketing calls to existing referral sources very productive and demonstrated my clinic outcomes compared with a risk-adjusted similar patient population. It highlighted our better outcomes as more efficient and effective and with high patient satisfaction. This gave my current referral sources more reason to continue to refer to us. Using similar reports allowed me to show my outcomes to new referral sources and helped differentiate my services from my local competitors. It was also helpful to point out that the reports were generated from an independent third party, not produced “in house.” This added more credibility to the discussion. Using an approximate value of each referral as $800, simply getting one new referral or adding one new referral source to our office easily paid for the cost of the outcome system I used for the entire year! In these scenarios, the ROI was almost immediate and became an important tool for increased profitability due to increased productivity and increased referrals to our clinic.

Using risk-adjusted, third-party outcomes data to justify inclusion in payer networks, as a selling point for improved rates, or as the new paradigm for participating in a pay-for-performance reimbursement system will be essential for the future. To be included in bundled payment, accountable care, and other CMS programs in place now or coming in the near future, you need risk-adjusted outcomes to be able to fairly compare your services to alternatives in the market. If CMS does implement Merit Incentive Payment Systems (MIPS) in 2019 and applies those rules to rehab soon after, your reimbursement will be dependent on your outcomes. It seems obvious to me as a user of outcomes for many years that the only way a provider will function successfully in such an environment is to start now to learn how to manage patients and the practice with outcomes. The ROI application here is more of a survival mode requirement.

Many of our operating costs are going up, especially staff salaries, supplies, and utilities. It is hard to justify the added expense that proper implementation of an internal outcome process or a purchased outcome management system requires until you realize that it can become a source of increased profitability and an efficient tool to measure quality of care, manage your practice and staff, and market your services.

Alfonso L. Amato, PT, MBA, has more than 40 years’ experience as a physical therapist. He serves as the president of Foto, which measures outcomes in rehabilitation, in Knoxville, Tennessee. He can be reached at alamato@fotoinc.com.

Telehealth Today

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An overview of telemedicine services in health care today as well as some specifics related to physical therapy practice.

Kelly Sanders, PT, DPT, OCS, ATC

Advances in both medical as well as communication technology have paved the way for the rise of telehealth. According to the American Telemedicine Association, more than 15 million Americans received some type of medical care remotely last year, and that number is expected to grow by 30 percent this year. Communication technology is allowing physicians and other health care providers to be accessible to patients for urgent care as well as specialty care when it may not otherwise be immediately locally available. This health care delivery medium has also increased the convenience of not having to physically visit a health care provider’s office or a specialty health facility. In addition, it is allowing for health care providers to access colleagues within the medical community, specifically in rural or underserved areas where a specialist may not be available locally for consultation. Telehealth becoming mainstream will make a significant impact on health care and should afford the health care community the ability to improve care delivery, access, and cost.

The New England Journal of Medicine recently published an article on the state of telehealth and identified three primary telehealth trends, the first being that telehealth is evolving from a medium that started initially as a means to improve access to care yet also is increasing convenience and will hopefully eventually lower health care costs. Second, we are seeing the migration from services for acute care conditions to now seeing telehealth grow to address more chronic conditions. The last significant trend identified is that telehealth is now not just being utilized in hospitals, facilities, and medical offices but in patient homes or on mobile devices.1

With this increased utilization and access to telehealth services, hurdles have appeared. Laws, regulations, and payment policy vary greatly by state, specialty, and payer. Given the infancy of this provider medium, each area of the health care dynamic is being evaluated with new legislation and policy being introduced. The types of care that are appropriate for the telehealth medium are starting to be defined, as well as guidelines for telehealth care.

Payment is likely the largest constraint to large-scale use of telehealth. The Centers for Medicare & Medicaid Services (CMS) is proposing expanded coverage of telehealth services with new Current Procedural Terminology (CPT) codes scheduled to go into effect in January of 2017. Currently, much of this care is limited to specific health care specialties, commonly in the areas of behavioral health, renal care, and other critical care areas. At present, CMS also limits the location of telehealth care, requiring that the patient be located in a medical office or facility (originating site requirement). One new proposed exception to this is home care under the Comprehensive Care for Joint Replacement (CCJR) program.

Despite limitations with telehealth payment success to date, the use of telehealth is on the uptick in organizations and agencies that have more financial risk or where costs are more closely embedded in the delivery of care. Examples of this are the Department of Defense, the Department of Veterans Affairs, and larger self-insured employers.

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As telehealth relates to physical therapy, there are additional challenges to work through. Third party payer coverage is significantly limited or unavailable, and CMS does not recognize physical therapists as eligible providers of telehealth care at this time. In 2015, the Federation of the State Boards of Physical Therapy published Policy Recommendations for Appropriate Regulation for telehealth in physical therapy.2 This document outlines the regulatory requirements specifically related to licensure as a physical therapist. At the time of publication, only three states have specific language related to physical therapy telehealth practice, so practice act and in-person regulatory standards prevail in most cases. Physical therapist licensure is required in whichever state the patient is physically located in at the time of care, and all regulatory and practice act guidelines apply based on the state the patient is physically located in as well.

Given all of the specifics for physical therapy, significant possibilities exist to integrate telemedicine into our care paths and services. As we look toward changes in payment, telemedicine may be a key component of bundled and value-based payment models. This may be a tool for practices to keep costs in check, and integrate telemedicine visits between “brick and mortar” clinic-based care for specific conditions. As an example, it seems logical that for a postoperative patient who underwent rotator cuff repair, we can see the patient in the clinic once a week and monitor progress and check status between weekly in-clinic visits via a telemedicine visit.

Overall, as this medium of care evolves it appears multiple positives related to access, convenience, and cost control will be available to our patients, practices, and providers. Continuing to follow solid evidence-based care guidelines, a responsible and thoughtful approach to patient selection for this medium of care delivery and continued focus on the patient experience should ensure success.

Kelly Sanders, PT, DPT, OCS, ATC, is president of Movement for Life, Inc, a group of physical therapy clinics operating in California, Arizona, and North Carolina. She is a member of the APTA PPS Payment Policy Committee as well as the Editorial Board of Impact magazine. She can be reached at kelly@movementforlife.com.

REFERENCES

1. Dorsey ER, Topol, EJ. State of telehealth. N Engl J Med. 2016;375;2:154-160.

2. Federation of State Boards of Physical Therapy. Telehealth in physical therapy: policy recommendations for appropriate regulation, 2015.

Copyright © 2017, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.