Is PT Valuable?
Only outcomes data will tell.
By Heidi Jannenga, PT, DPT, ATC/L
It is 2016—and we are living in a world where everyone wants to get more for less, even in health care. In fact, our entire country is in the midst of a massive health care reform effort, much of which is focused on delivering higher-quality care at a lower cost—which explains why so many of the recently created health care regulations, programs, and payment models reward value.
So, how does this impact physical therapists? We know our services are valuable, but unfortunately, that value is not widely understood or accepted among payers, patients, or other providers. It is our responsibility to change that—to make sure everyone knows how valuable physical therapists really are. This will ensure we do more than survive this new, value-based health care environment; we will thrive. First, we must actually prove the value of our services, ourselves, and our profession. And we must do so objectively—with outcomes data.
The Triple Aim
You may be wondering why tracking patient outcomes is so important all of a sudden. While it has always been an important aspect of evidence-based practice, the demand for this type of data collection has amplified in the last few months as a result of the Institute for Healthcare Improvement’s Triple Aim,¹ which is the driving force behind US health care reform. As the name suggests, the Triple Aim has three main objectives:
- Achieving better results (i.e., better patient outcomes)
- Decreasing the cost of care
- Increasing patient satisfaction
If you have been practicing for even a short while, you know how common it is for things in the policymaking world to move at a turtle’s pace. However, that is not the case here. In fact, the federal government is not wasting any time in its quest to reduce health care spending. To that end, in 2015, the US Department of Health and Human Services (HHS) announced it will:
- Base 30 percent of all Medicare fee-for-service (FFS) on alternative payment models by the end of 2016.²
- Increase that proportion to 50 percent by 2018.²
- Link 85 percent of FFS payments to outcome measures by the end of 2016.²
- Bump that percentage to 90 percent by the end of 2018.²
This rather aggressive timeline means that providers who do not jump on the outcomes-tracking train may end up feeling the pinch of an even more dire payment situation. Think about it: Medicare payment rates are already a common cause for complaint—and private payers tend to follow Medicare’s policy lead. So, in all likelihood, most—if not all—payments will be linked to value within the next few years.
So, what is outcomes tracking, anyway? In short, it is a way for health care providers to objectively measure patients’ functional progress and success via outcome measurement tools (OMTs). Typically, patients complete these at the onset of care, at the end of care, and at various points between. Of course, you, as the physical therapist, are able to see each patient’s progress, but the only way to draw meaningful conclusions about your patients’ progress overall—as well as your staff’s performance as a group—is to track those outcomes in an objective and scalable way. In other words, in order to demonstrate your value as a physical therapist, you need data—and outcomes tracking is the best, most logical method of obtaining that data.
Now, that being said, there is a big difference between merely recording numbers and generating meaningful, actionable insights, because when you do the latter, you can achieve three really important things:
1. Improve Patient Care
Outcomes data is unique, because it is tied to the efficacy of care. When providers can proactively collect and analyze this information themselves, they gain insight that they can use to improve care, streamline operations, identify best practices, and guide business decisions. The benefit of outcomes data does not stop at the individual provider level: When therapists create a large pool of collective data with the intent to improve patient care, the entire industry benefits, because we gain the ability to prove the effectiveness of physical therapy across the board. When we do that, payer networks will have more of an incentive to make physical therapy widely available and affordable to beneficiaries, which means patients will have better access to our cost-effective, noninvasive treatments.
2. Influence Payment Rates
In the past, many therapists shied away from collecting outcomes data because they were afraid it would negatively impact their contracts and, as a result, their finances; and that fear had some merit. Luckily, though, times are changing, because more of the data we are collecting today actually reflects the value we provide our patients. As an industry, we have the opportunity to demonstrate our ability to improve our patients’ lives and highlight the downstream cost savings we achieve. Once we collect enough data, we can leverage it to negotiate better payment rates, boost referrals, and even advocate for policies that ensure we are taken into consideration for future payment models. The more data points we gather, measure, and transform into meaningful, actionable information, the more influence we will have in creating the future we want.
3. Position Physical Therapists as Key Health Care Players
According to a research study cited by the American Physical Therapy Association (APTA),³ patients who seek therapy early in the course of treatment for low back pain generate significantly lower health care costs than patients who do not. And that is just one study. There are plenty of other musculoskeletal conditions for which this holds true. Unfortunately, it seems we might be the only ones who know this—because the general public does not. And with collaborative care models becoming the new norm, it is time we step in and claim our position as primary care practitioners—and command the recognition we deserve. To do so, we need concrete proof that definitively shows the results we are capable of achieving. In other words, we need outcomes data—and the right kind of outcomes data at that. This means we must:
- use standardized tools to collect outcomes data,
- select measurements recognized outside of the rehab therapy realm, and
- push to make our findings more widely available outside of individual clinics.
The Benefit to Your Practice
By now you know that outcomes data is an important piece of the proving-our-value puzzle—and that it impacts both care quality and payments. You also know that if physical therapists produce outcomes data on a large enough scale, it will help all of us better assert ourselves as neuromuscular experts. But those are longer plays. What about some immediate gratification? Well, as it turns out, outcomes data actually can help you be a better physical therapist and run a better practice—now. That is because you can use the data you collect to:
- Better assess clinical performance through benchmarking.
- Compare your clinic’s data to various data points for clinics in your region/specialty.
- Identify areas of need/competitive deficiencies and create correctional plans.
Sounds good, right? Now, on to the tactical stuff.
We are all clear on why outcomes data is beneficial and important, so let us talk about how to start tracking it. First of all, you can breathe a big sigh of relief, because you’re probably already completing outcomes tools and recording the information as part of your standard documentation, which is great. All that is left, then, is to establish the right processes and implement the right software—because to collect and analyze data in an accurate, timely, and consistent manner, you will need some type of software.
Of course, if you prefer to administer paper tests to your patients, you can still print them out, but it is best to record and store the results in a therapy-specific outcomes tracking software. I suggest doing so in a user-friendly, web-based system—preferably one that integrates with your electronic medical records (EMR). That way, you do not have to waste time—or risk any associated errors⁴—with double data entry. Plus, the system will instantly record the data you collect within the appropriate medical record. This type of software makes it much easier to hold yourself and your staff members accountable for consistently collecting outcomes information. This last step is important, because with any data-tracking endeavor, consistency is key.
Additionally, the right software contains a hand-picked library of evidence-based, industry-accepted tests that are already familiar to—and respected within—the health care community at large (e.g., QuickDASH, LEFS, Oswestry, Neck Disability Index, and Dizziness Handicap Inventory). You also want those tests to be risk adjusted for complicating factors such as age, weight, litigation, diabetes, cancer, and heart diseases, so you can easily and accurately compare different types of patients.
Now, collecting meaningful data will take a little bit of extra work, but think of it less as a burden and more as an opportunity—one that will soon be the norm. Like any worthwhile endeavor, the end result is worth it. Physical therapists have a huge opportunity here to shine in this pay-for-performance era—and to take the driver’s seat for a change. If we execute on this correctly, we will have the power to save our patients money, improve our clinics’ bottom lines, and solidly position ourselves as primary care providers. Now that is a win-win-win.
1. The IHI Triple Aim. Available at www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx. Accessed February 12, 2016.
2. Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. HHS.gov (2015). Available at www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html. Accessed February 12, 2016.
3. Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients with LBP. Early Guideline-Based Physical Therapy Results in Health Care Savings for Patients With LBP (2015). Available at www.apta.org/ptinmotion/news/2015/4/9/adherentptlbp. Accessed February 12, 2016.
4. Goldberg SI, Niemierko A, Turchin A. Analysis of Data Errors in Clinical Research Databases. AMIA Annual Symposium Proceedings (2008). Available at www.ncbi.nlm.nih.gov/pmc/articles/pmc2656002. Accessed February 12, 2016.
Heidi Jannenga, PT, DPT, ATC/L, is the founder and president of WebPT. She can be reached at email@example.com.