Why Outcomes Matter

Demonstrating value is only the beginning of the list of benefits

Vol. 27 • Issue 8 • Page 8

Management Focus

While the rehabilitation specialties are growing professions, they are still widely misunderstood. The public often equates physical therapy with chiropractic or massage, and occupational therapy with arts and crafts time at the local nursing home. Payers often perceive us as an interchangeable commodity and seek the lowest bidder.

The confusion is worsened by practice variability, sporadic use of evidence-based clinical guidelines, a lack of standardized terminology for many procedures, and a healthcare system that’s modeled to measure illness and injury, not function. The routine use of evidence-based outcomes systems is sporadic.

Defining and Using ‘Outcomes’

One problem I encounter is that we use the term “outcomes” to mean different things:

  • Use of standardized patient-reported outcomes in individual patient documentation;
  • Patient satisfaction measures;
  • Use of “outcomes” that have a dubious basis in evidence. Medicare’s Functional Limitation Reporting comes to mind.

For this discussion, let’s define outcomes as the analysis of validated, evidence-based, patient-reported outcomes across a patient population. The analysis might be within your organization, region, or the entire country.

Patient-reported outcomes provide a mechanism to help us prove value. But most of us are not using standardized outcomes reporting to measure effectiveness.

In a poll of PTs and OTs from across the country attending a webinar we hosted in March 2016, most respondents indicated that they are not analyzing their outcomes, even though 45% of them reported using patient-reported outcomes to assess individual patient progress. Over 60% of those not using a commercially available outcomes analysis system cited the primary reason as time constraints. It seems clear that most of our colleagues do not perceive outcomes data analysis as being valuable.

If time constraints are the biggest barrier to adopting patient-reported outcomes, we need to integrate outcomes as part of our routine workflow while decreasing the effort of the therapist. A seamless integration of patient-reported outcomes into your electronic medical record will save time and improve documentation.

Beyond Demonstrating Value

A seamless integration with an evidence-based outcomes system has a number of benefits beyond demonstrating value. Here are a few.

Clinical quality improvement. Routine use of patient-reported outcomes allows us to evaluate clinician performance and target continuing education aimed at opportunities for improvement.

Marketing. Outcomes data may be used to market your organization’s effectiveness to payers and referral sources. As your patients assume more of the financial responsibility for their healthcare out of their own pockets, using this data to market directly to consumers is becoming more important.

Preparing for value-based care. No one really knows how quickly the transition from a fee-for-service system to pay-for-performance is going to take, but every expert I’ve spoken with tells me it’s inevitable. You need to begin preparing now to demonstrate value.

Negotiating contracts. You need to get out of the “commodity box,” and differentiate yourself by demonstrating value so you’re able to negotiate payer contracts from a position of quality rather than on lowest price.

Process improvement. We need to ask ourselves some hard questions so we can optimize our services.

How much therapy is enough? How much care can be assumed by assistants without compromising quality? How can we insert ourselves into the healthcare system so that patients are getting rehab services at the right time? Without a framework to show value, none of those questions can be answered.

Process improvement can provide both the time savings and business value to drive your business forward. Simple concepts can help move from patient to payment, and eliminate much of the manual labor and busywork associated with running a practice. This enables our customers to focus on patient care.

Moving Forward

I believe that the change coming within the next 2-5 years requires a shift of focus so that patient-­reported outcomes become a routine part of the clinical workflow.

There seems to be little doubt: Value-based reimbursement is coming soon, effective use of patient-reported outcomes will be central to success in a pay-for-performance world, and the time to begin preparing is now.

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