We continually have the opportunity to meet and interact with physician practice administrators and physical therapy clinic directors from all over the country. A common phrase we often hear when the conversation turns to their therapy clinic’s performance is, “We THINK we’re doing OK, but we don’t really know what we don’t know”. Today, we’ll review some of the key parameters we measure and why you should, too.
CLINIC OPERATIONS
Most therapy facilities have some mechanism(s) they use to measure key operational metrics, e.g. visits per new patient, units of service per visit, cancel rate, capture rate, and visits per FTE. It’s one thing to capture the info; it’s another thing entirely to understand what the data is telling you. As we review some of these metrics below, consider how your practice is performing in these areas and how you could be doing better.
While these variables have commonly been used to assess clinic operations for some time now, providers and managers must be preparing to view operational metrics in a different light as payment models shift from traditional fee-for-service to value-based reimbursement. It will be essential for clinicians to focus on the utilization of best practices in delivering efficient, low-cost care which provides the best possible outcomes.
CLINICAL OUTCOMES
We recently concluded a three-part blog series on clinical outcomes in which we reviewed the importance outcomes will play in alternative payment models as well as the components of outcome measure tracking including patient perception questionnaires, patient-reported outcome measures (PROMs), and industry-standard assessment tools.
We know that outcomes will be playing an increasingly important role as healthcare moves towards pay-for-performance and outcome-based payment models. However, the importance of tracking meaningful clinical outcomes extends well beyond the need to provide payers with outcome data. Outcomes can play a key role in the day-to-day management of the clinic. Therapy providers can grow weary of operational metrics as an indicator of their performance and often begin to “tune out” discussions about “the numbers”. Clinical outcomes, however, are usually more relevant to clinicians but still have a direct impact on the operational metrics.
Is your practice currently capturing clinical outcome data? If so, how are you utilizing that information to improve the patient experience, to help your therapists assess their effectiveness, and to make improvements to the delivery of care?
REVENUE CYCLE AND DENIAL MANAGEMENT
The follow-up on therapy claims can be a challenging in itself as payers often have different billing and documentation requirements. Questions to consider when reviewing your therapy claims and denials may include:
Failure to address the issues above can hold up the processing of therapy claims and lead to denials and/or reduced payments.
REGULATORY AND LEGISLATIVE CHANGES
Many practice administrators have indicated that they often find themselves overwhelmed with the regulatory changes affecting physical therapy as these are often different or entirely separate from initiatives they must adjust to on the physician side. Within the last few years alone, therapists have found themselves struggling to keep up with changes to payer documentation requirements, PQRS, functional limitation reporting, therapy caps, etc. In the coming years, therapists must once again adjust to new quality reporting requirements as the Merit-Based Incentive Payment System (MIPS) comes into play. It is important to stay on top of these developments in order to make necessary modifications to operations and assist your therapy team in learning how to adapt to the changes.
HOW TO KNOW WHAT YOU DON’T KNOW
To learn more about how Integrity Rehab Group can help answer these questions and more, check out our website at www.irg.net. For those who are attending AAOE in San Francisco, please visit us at Booth #305 or drop by our Fast Track sessions on Friday, June 10 from 2:00 – 3:05 pm in Franciscan C. The Fast Track topic is titled: “When it comes to physical therapy, do you know what you don’t know?” Hope to see you there!
The hand is a complex and delicate part of our body that we use for…
MEDICARE PHYSICIAN FEE SCHEDULE FINAL RULE CMS released the 2021 Medicare Physician Fee Schedule final…
With the year coming to a close and the publishing of the 2021 Medicare Physician…
The Physical Therapy Compact Commission announced on March 2nd that compact privileges will be available…
Palmetto GBA has published communication to providers regarding the NCCI Procedure-to-Procedure (PTP) Edit Replacement Files. …
As part of the final 2020 Medicare Physician Fee Schedule Rule published in November, CMS…