Clinical Outcomes: Fad or Trend?

This post is the first in a series aimed at capturing, reporting, and the relevance of clinical outcomes in the outpatient physical therapy environment. 

As healthcare continues to move toward alternative payment models and value-based reimbursement, providers are hearing more and more about the importance of capturing clinical outcome data and assessing the quality of the care provided.  From a therapy standpoint, the questions we most often receive on this topic pertain to what information therapy providers should be capturing, how to make sense of the data, and why any of it matters.  We realize that therapists are already a bit weary from capturing and reporting PQRS and functional limitation reporting data which, to this point, has had little relevance or impact on the delivery of care for PTs and OTs.  Therefore, it’s understandable that some providers may view the capturing of outcome data as nothing more than just another hurdle that must be cleared in their daily routine.  However, clinical outcomes play a much more important role than just serving as the latest buzzword in the healthcare lexicon.

ALTERNATIVE PAYMENT MODELS AND THE SHIFT TOWARD OUTCOME-BASED PAYMENT

Earlier this month, the Department for Health and Human Services (HHS) announced that it had met its goal (by almost a year) of tying an estimated 30% of Medicare payments to alternative payment models that reward the quality of care over quantity of services provided to beneficiaries.  These alternative payment models include Accountable Care Organizations (ACOs) and bundled payment arrangements.  HHS plans to tie 50 percent of payments to these models by the end of 2018.  Overall, HHS plans to link 85% of remaining fee-for-service payments to outcome measures by the end of 2016 with that goal increasing to 90% by 2018.  Clinical outcomes will play a role in determining and quantifying the quality of care provided.

Furthermore, in attempt to help standardize relevant outcome data for physical therapy, the APTA has been developing its Physical Therapy Outcomes Registry, a system for collecting data to evaluate patient function and other clinically relevant measures.  The goals of the registry are to inform payment for physical therapy services, improve practice, fulfill quality reporting requirements, and promote research.  Per the registry’s website, this outcomes database will enable the physical therapy community to “demonstrate the value of physical therapy services to payers while also enhancing patient care by providing participating physical therapists with benchmarks from which to build evidence-based care plans” in an evolving healthcare environment in which increased scrutiny is being placed on outcomes.

OUTCOME vs. OPERATIONAL DATA

So it would appear that the discussion surrounding clinical outcomes is only going to increase in the months and years to come.  That’s not a bad thing.  As mentioned before, I realize that therapy providers are already capturing and reporting a significant amount of information for PQRS and functional limitation reporting.  It remains to be seen if and how CMS uses functional limitation data, and for clinicians who are now in their fourth year of reporting functional G-codes, the process no doubt feels like nothing more than an extra step in our documentation with no real relevance in terms of clinical decision-making.  Therefore, it’s understandable that the thought of collecting even more data may not be all that appealing.  However, while it may be some time before we have reliable, comparable data to use in order to truly reform payment models, that doesn’t mean providers should ignore the importance of capturing clinical outcome data now.

Most therapy providers have measured operational metrics such as visits per FTE, visits per new patient, units of service per visit, cancel rates, etc. for decades now and then used that data as the primary means to analyze productivity and the efficiency of care.  Clinical outcome metrics, though, have traditionally been harder to quantify or neglected altogether but are certainly no less important.  To illustrate that point, my staff used to play “Staff Meeting Bingo” during our monthly meetings in which they would mark their cards every time I would mention words like “productivity”, “budget”, “VPR”, etc.  It was light-hearted and fun, but the point stuck with me that our clinicians began to tune out the numbers stuff after a while.  They weren’t inspired by operational metrics.  Over time, our emphasis shifted to looking at the clinical outcomes piece and how we could use that information to better serve our patients.  As a result, we found that a focus on measuring clinical outcomes and our patients’ perception of their therapy experience would drive all of the other operational data and help us quantify the quality of care we provided.

DEFINING QUALITY CARE

Now, I realize the term “quality care” has become so commonplace that it has almost lost any real meaning.  Even as we move to outcomes-based payment models, we don’t have a clear understanding or consensus as to the definition of “quality care” in the outpatient therapy setting.  There is not a standardized process by which clinical outcome data is captured or reported by therapists who are currently collecting this information.  What may be an important clinical outcome metric to one clinician may not be as important to another.

To me, quality care incorporates a comprehensive approach to treating the patient which includes education, manual therapy, modalities (when appropriate), and an emphasis on therapeutic activities that relate to function.  When all of these things are incorporated into the treatment of the patient, we increase the likelihood that the patient will perceive value in the services we provide which in turn improves patient compliance, facilitates the achievement of the patient’s goals, and leads to better clinical outcomes.  In that sense, “quality care” is ultimately defined by the patient based on their perception of the services we provide.

In the coming weeks, we will continue this series of blog posts focusing on the capture and analysis of clinical outcome data including a review of how outcomes can be a powerful tool in the management of your practice.