Tracking for Success


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.


1. Accessed November 2016.

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

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