Clinical Outcomes Part 2: Deciding What to Measure

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

In the previous blog post, I talked a little about the role that outcomes will play in a value-based reimbursement environment as well as the importance of outcomes in managing your clinic and in helping to assess the comprehensiveness of care provided.  Over the next few weeks, we will dig a little deeper into determining what metrics you may want to measure and how to collect the necessary outcome data.

OPERATIONAL vs. OUTCOME DATA

Most therapy providers have been collecting some form of operational data for years.  Metrics commonly captured to assess clinic productivity and efficiency have typically included visits per FTE, visits per new patient, cancel rate, and units of service per visit.  With the emergence of bundled payments and the Comprehensive Care for Joint Replacement Model (CJR), providers are also scrutinizing cost per episode more closely.  Equally significant, though, is the ability to capture and report clinical outcome data.  Not only do clinicians need to make sure they are delivering cost effective care, they also need to ensure that patients are being discharged from therapy with maximum results.  That being said, common questions we hear from providers pertain to what information they should be capturing and how they should apply it.  After all, it’s one thing to be able to collect the data, but it’s another to know what to do with it once you have it.

VIEWING OPERATIONAL DATA AS OUTCOME DATA

Before we get into specific outcome measures, I might suggest that we change how we view the operational metrics mentioned above and start looking at these key operational indicators AS outcome data.  Let’s use visits per new patient as an example.  Most clinics have a goal as to what they consider to be an acceptable target for this metric.  Often, that goal is based on past performance, industry standard, or some other benchmark.  However, rather than just looking at visits per new patients as an operational metric, clinicians can view this as an indicator of how well they are progressing patients through to discharge versus patients dropping out or failing to finish their prescribed plan of care.  By understanding how this particular metric is measured and its connection to the clinical outcome for the patient, the clinician can dive deeper into what is happening during treatment sessions, how patients are being progressed, and when and why patients are being discharged from the program.  Similarly, clinicians can view units of service as an indicator of the comprehensiveness of treatment sessions and how much time therapists are spending with patients.  Cancel/no-show rates can be viewed as a quality indicator of the frequency at which patients are electing not to attend scheduled appointments and why they aren’t making therapy a priority.  Perhaps the patient doesn’t perceive value for the time and money they are devoting to therapy.  Maybe the patient fails to see progression or the benefits of therapy.  This is where measuring specific clinical outcomes can help provide more insight as to the patient’s perceptions of their therapy experience.

PATIENT PERCEPTION

One of the most common methods of assessing the patient’s perception of their care is the patient satisfaction survey.  These have been around for decades, and most healthcare providers nowadays use some form of survey tool, be it paper or online.  Through the years, I have used a variety of patient satisfaction tools, some of which were quite detailed and addressed many areas of our clinic operations ranging from patient care to their impressions of the front desk staff to the cleanliness of the facility and more. Over time, I have favored shorter surveys with a focus on key elements of the patient’s care, primarily the patient’s overall satisfaction with their care, the degree to which their expectations were met, and their perception of their functional improvement.  These tools require less time to complete and give us the most important components of what we want to know about the patients’ experiences and how they perceive the value of the care provided.

Regardless of the length of the survey and the number of questions asked, what is most important is what you do with the feedback.  While negative comments are something you never want to receive, they do allow you the opportunity to follow up with patients who indicate dissatisfaction with the services provided and make changes in areas that you may not have even realized were problematic.  I once had a patient who did wonderfully in therapy and met all of his goals.  I was surprised, then, when he returned his satisfaction survey with a “dissatisfied” response.  Upon contacting the patient, I learned that he was very satisfied with his care but was frustrated with the lack of handicapped parking spaces.  It was enough to make his therapy experience less than ideal.  His response to the survey allowed us to address the issue and prevent that from becoming a negative for future patients.

Our method of collecting patient satisfaction data consists of asking a short series of questions at the patient’s last visit.  These questions are part of an exit questionnaire that includes an assessment tool mirroring the one that the patient completed at their initial visit.  We can then compare their initial assessment tool score with their discharge score in addition to capturing their patient satisfaction data.  This information is then entered into our practice management software system from which we can run a variety of operational and outcome reports.  We also have the ability to filter the data by payer, physician, therapist, and diagnosis and then share the results with therapy staff, physicians, and insurance carriers.  When we first built our system from scratch several years ago, there were few outcome reporting systems in the market.  Obviously, there are many more outcome tracking systems available today.  However, by getting a jump start on collecting data, we now have tens of thousands of patient cases with outcome data which we use every day in assessing performance and establishing benchmarks for our clinicians.

In our next blog post, we will review the utilization of assessment tools to measure and track patient progress from the start of care through discharge.  In the meantime, if you have questions about how IRG can help you with outcome data tracking and reporting, feel free to leave a comment or check us out online at www.irg.net.