Protect Your Legacy: A New Metrics Model for Long-Term Success

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Take a counterintuitive approach to cost control.

By Jeanine Gunn, PT, DPT, and Heather Chavin, MA
August 2018

Private practice owners are all familiar with the cost containment portion of the Quadruple Aim (enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers, including clinicians and staff).1 Metrics like vacancy rate, denial rates, new patients, and units per hour all make our list of key performance indicators (KPIs).

These metrics are important, but they are not the whole story. They measure the short-term success of your practice. What metrics do you use to monitor longterm success? What metrics will have an impact on your turnover costs, your reputation, and your referral relationships? Which metrics speak to your legacy?

In building your practice’s long-term health, shift your focus to different sections of the Quadruple Aim, specifically Satisfied Providers and Satisfied Patients. Measure and improve these lead indicator metrics and you will see an impact on the lag indicator metric, your bottom line.


Most practices start using outcomes tools as a response to payer requirements. Your entire practice will be better served if you integrate them as tools your practitioners cannot live without, because they inform their clinical decisions.

As we know from Daniel Pink’s oft cited Drive, one of the factors of intrinsic motivation is mastery.2 We are happiest at work when we feel competent. Providers need access to real-time functional outcomes. Projections for improvement over an average number of visits will help them set expectations with patients. Monitoring progress throughout the plan of care allows practitioners to course-correct when needed or ask for help when improvements stagnate.

How exactly you work with your functional measures will differ based on practice and provider. A recent graduate might strive to meet the minimal clinically important difference (MCID) for each patient. A veteran might try to beat national averages in functional change. No matter the goal, you cannot strive for improvements without real-time data throughout the plan of care.

The bridge metric between provider satisfaction and patient satisfaction is your self-discharge rate or conversely, your rate of completed plans of care. The higher the proportion of self-discharges, the lower the true value of your customer satisfaction data. These lost patients are not likely to be promoters of your clinic. Also, without an official discharge, when does the patient receive the message that they have succeeded? Does the provider know if they have met the patient’s expectations? When do you ask for reviews or a good word to their doctor?

The obvious source for patient satisfaction metrics is a patient satisfaction survey. Commercial outcomes platforms all include them. If you are tracking outcomes in-house, there are open source versions on the web. You and your staff choose which areas of patient satisfaction to prioritize in the survey.

One area critical to include is the Net Promoter Score (NPS). The NPS rates how likely your patient is to recommend you to others. It measures your word-of-mouth advertising strength. If you are not at 95 percent, you are falling behind.

Also nonnegotiable is the patient’s satisfaction with their treatment progress, required input when striving for patient-centered care. Even if the patient has positive regard for their therapist influencing their perception, they still may not feel that they have progressed as far as they wanted to. If this score drops, your NPS will follow.


The “why” of your organization comes from what you have demonstrated to be important through your actions and consistent deliberate messages. The data you use to make decisions is an expression of what you have labeled as important. It is an expression of your why.

If all you use is vacancy rates and number of new patients, you communicate that your “why” stops at the bottom line and you value your employees accordingly. This creates a stifling environment for innovation, empathy, and patient-centered care.

Your “why” must extend to your entire team. Your office staff and care extenders are a vital part of your care team, and they need to be an integral part of building your “why.”


No matter where you are in your outcomes utilization, reflect on the following questions. Do you have buy-in from all members of your team? Do you have a clear process for collecting data and communicating the value to the patient? Do you all have access to the data collected? Do you use that data to fuel change initiatives?

Effectively implemented systems share three qualities: a “why” for each member of the team, input from each member on the process,3 and reinforcement from the leadership that this system is of value.

The best way to illustrate these is through an example. Not long ago, I was working with a large clinic whose owner shared with me his difficult transition when finally getting rid of their dictation service and transitioning to their new electronic medical record (EMR) system. The owner was perplexed that the transition was so difficult. He outlined his logical decision-making process and the amount of warning he gave before the service was discontinued. Some of his clinicians used the service until the day it was shut off and then were surprised to find it gone.

He had another transition in the works and wanted a better process for implementation. He was looking to become more effective at collecting and using his outcomes data. This was going to require changes from the front office staff and practitioners to get him the data he wanted as the owner. We discussed how to integrate the qualities of an effective implementation into his transition plan to make this transition more effective than the last.

Here is the process we outlined together:

Step 1: In a staff meeting, revisit why he wants to collect outcomes data and give the “why” for the business. He will be brief.

Step 2: Before his office lead gives the staff a tour of their outcomes platform, he will let his staff know that he will be asking the following questions: “In what ways might you get something useful from our system?” “How do you see yourself benefiting from the data?” “What data do we need that this system won’t provide?”

Step 3: After the tour, the staff members’ answers will be shared and recorded. The owner will make sure everyone contributes. From the second question, he should be able to articulate the “why” of each staff member.

For example, two of his front office staff may agree that they want to monitor patient satisfaction around the scheduling process. When asked how it will benefit them, one notes that he enjoys making things easy for the patients; the other wants it to measure her efficiency. The same data holds different relevance for each staff member. But relevance is what will keep them engaged.

You might see the same thing from clinicians. Your new clinician will strive to hit MCID to feel confident she is providing value to her patients. Your clinician spending time and money on a manual therapy certification is interested to see if his functional change data moves above the national average.

Step 4: The owner will pay special attention to the people expressing negativity or who appear disengaged. Rather than getting defensive, he will dig to find where their resistance or apathy is coming from so valid concerns can be acknowledged and addressed.

Step 5: He will prompt his staff that the next meeting will be spent building a system and an implementation plan together. The one requirement of the plan is that it meets the needs of every “why” in the room. If it takes more than one meeting, they will take the time.

Step 6: The new system will stay on the agenda for six months as they test and revise. Each staff member will share both frustrations and how their “why” is improving their work life.

Step 7: Once he feels the system has been implemented effectively, he will congratulate his staff on their hard work and ability to manage the stress of change. He will help them see themselves as capable change managers, paving the way for the inevitable next big change.


1 Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576.

2 Pink D. Drive. New York, NY: Riverhead Books; 2009.

3 Yoerger M, Crowe J, Allen J. A. Participate or else!: the effect of participation in decision-making in meetings on employee engagement. Consulting Psychology Journal: Practice and Research. 2015;67(1):65-80.

Jeanine Gunn, PT, DPT, is a PPS member and chief operating officer at Therapeutic Associates Physical Therapy. She can be reached at

Heather Chavin, MA, is a member of the PPS Administrator’s Alliance and the business partnerships manager at CareConnections Outcomes Platform. She can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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