Advance for Physical Therapy & Rehab Medicine, June 22, 2016, By: Jerry Henderson

While rehab specialties are growing professions, they are still widely misunderstood. The public often equates PT with chiropractic or massage and OT with arts and crafts time at the local nursing home.  Payers often perceive us as an interchangeable commodity and seek the lowest bidder for provider contracts. The payer 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 is modeled to measure illness and injury, not function.

The routine use of evidence based outcomes systems is sporadic, and even where outcomes systems are utilized routinely, they are not necessarily used effectively. In my experience, they are often perceived by therapists as “one more thing” they need to do to get through their caseload for the day, not as an important piece of their clinical practice.

Defining “Outcomes”

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

  • Use of standardized patient reported outcomes in individual patient documentation without analysis across a patient population
  • Patient satisfaction measures
  • Use of “outcomes” that have a dubious basis in evidence. Medicare’s Functional Limitation Reporting comes to mind, as do some other widely used outcomes questionnaires that have not been validated.

For the purposes of our 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.

Why Don’t We Use Outcomes? 

The use of Patient Reported Outcomes provides a mechanism to help us prove value.  But, most of us are not using standardized outcomes reporting to measure effectiveness. So, the value of providing outcomes data does not seem to be worth the cost for most of us.

In a poll of PTs and OTs from across the country attending a recent webinar we hostedi, most respondents indicated 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 a primary reason as time constraints.

Outcomes Data Analysis and Value Perception 

It seems clear that most of our colleagues do not perceive outcomes data analysis as being valuable. They are not yet willing to invest the time, money, and diligence necessary to implement a truly effective outcomes analysis process. As we transition from fee for service to pay for performance, patient reported outcomes are going to play an increasingly important component of our ability to show value.

Seamless Integration with EMR 

If time constraints are the biggest barrier to adopting Patient Reported Outcomes, we need to integrate outcomes as a part of our routine workflow while at the same time decreasing the effort of the therapist.  We believe that a seamless integration of patient reported outcomes into your electronic medical record will provide time savings, while at the same time improving the clarity, quality, and value of your clinical documentation.

Beyond Demonstrating Value 

A seamless integration with an evidence based outcomes system has a number of other 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.


Outcomes data may be used to market your organization’s effectiveness to payers and referral sources. As your patients pay for more of the financial responsibility for their healthcare out of their own pockets, the ability to use 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 fee for service system to pay for performance is going to take, but every expert I have spoken with tells me it is inevitable. You need to begin preparing now to demonstrate value.

Negotiating Contracts 

You need to have a way to get out of the “commodity box”, and differentiate yourself by demonstrating value so you are 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? Are there routine services that can be automated? 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 the business value to drive your business forward.  This visual provides some simple concepts that help move from patient to payment, and eliminate so much of the manual labor and busywork associated with running a practice.  This enables our customers to focus on what matters most, the patient, while sustaining their business.

Moving Forward

I believe the change coming in the next 2-5 years requires a shift of focus and an optimization of business processes so that patient reported outcomes become a routine and seamless 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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