HOW TO USE OUTCOMES TO IMPROVE INCOMES

MIKE MUNDRY, PT, DPT

MIKE MANZO, PT, MPT

ATLANTIC PHYSICAL THERAPY CENTER (NJ)

ABOUT ATLANTIC PHYSICAL THERAPY CENTER

• Started 2001

• 14 locations, 106 employees

• On pace to complete over 120,000 visits this year

WHY OUTCOMES?

• “The primary aim of modern healthcare systems is to realize optimal health outcomes for patients and populations and to deliver services that are of the highest possible quality. 1

• High quality healthcare has been defined as care that is:• Safe --- Do not harm someone• Timely --- Received when needed and done so efficiently• Equitable --- Fair for all parties• Effective --- Get desired results• Patient Centered --- What is important to the patient (not the provider)

WHY OUTCOMES?

• More conscious consumers of healthcare dollars (higher deductibles / patient responsibility / HSA & HRA)

• Tangible evidence to demonstrate the value you can provide.

• Clinical Improvement by clinician and organization.

• P4P Pay For Performance is coming.

• Differentiate from your competition.

TYPES OF OUTCOMES MEASURES

• Patient Satisfaction -- Measuring service aspects of care systems• NPS (net promoter score) – gauges loyalty of

practice’s customer relationships.• More than 2/3 of Fortune 1000 companies use this

metric.• How likely is it that you would recommend our

company/product/service to a friend or colleague?• Scoring is most often a 0 to 10 scale.

TYPES OF OUTCOMES MEASURES

• Patient Satisfaction• Identify problems early and ADDRESS

(systems).• Promoters / Detractors• Different points in rehab timeline (early)

and at termination of care.• Easy visual on WebPT patient charts to

see most recent

CLINICAL DASHBOARD

PATIENT REPORTED OUTCOME MEASURES• Need a portal or system to aggregate data and measure results.

• WebPT Outcomes – system we use

• Foto – Focus On Therapeutic Outcomes

• Major areas covered in our company:• NDI – neck / cervical• Quick DASH – upper extremity problems• ODI – low back patients• LEFS – LE problems• DHI – vertigo / balance

IF YOU DO NOT MEASURE IT, YOU CANNOT IMPROVE IT

BENCHMARKING AGAINST PEERS

• Overall company clinical improvement• APTC Example (DHI results)

Your Company National

Initial 42.8 45.6

Completion of Care 22.9 21.3

Difference 19.8 24.3

% Change 49.9 53.5

Dizziness Handicap Inventory (Neuro)

INTERNAL STEPS TO IMPROVEMENT (APTC EXAMPLE)

• Identify area of underperformance – DHI (vertigo)

•Targeted CE and point person with strong interest – key employee (5-day course)

•Develop algorithm to assist clinicians – (deal that we invest in her, she does this)

•Key clinicians in each area to specialize – algorithm spurred interest (1-2 day CEs)

• Identify steps in processes that may be affecting scoring (BPPV cases no formal DC)

RESULTS

Your Company National

Initial 44.3 48.3

Completion of Care 15.9 20

Difference 28.5 28.2

% Change 62.4 54.7

Dizziness Handicap Inventory (Neuro)

MARKETING• 1.) To public – post your results (if they

are good)• Social media (Website banner, Instagram,

Twitter)• Internally within offices (signs, educate

staff for discussion purposes – clinical and reception)

Website

Instagram

Twitter

MARKETING

MARKETING

• 2.) To Physicians• Many ways to slice the data• Comparisons of APTC vs the Nation• Results of Dr. X lower extremity cases

vs all other lower extremity cases.• “How about my knee patients vs

Doctor down the street?”

COMPANY IMPROVEMENT•Strong office paired with weak office•Share strategies and techniques

•Compare PTs as individuals

•Create incentive programs around outcomes

•Compare outcomes based on payor class

INSURANCE CONTRACT NEGOTIATION

• Research and identify who the decision makers are

• Be persistent

• They have ALL metrics on you (visits, units, length of care, cost of care etc...)

• EXCEPT

• Outcomes data• Very important that you provide this data coupled with efficiency of care

PAY FOR PERFORMANCE

CHANGE HAS ARRIVED

•Quote from John Scull: “We see healthcare

shifting from a procedural reimbursement

to a world where people will be reimbursed

for the outcomes”

•This represents a shift from fee-for-service

to value based.

•Nobody likes change, but it has arrived as Medicare Access and CHIP

Reauthorization Act (MACRA)

•Prepare for the change, because it is the future in Merit-Based Payment

System (MIPS) and Alternative Payment Models (APMs)

•Move from fee-for-service to quality, performance, and outcomes

•due to rising healthcare costs and overspending

•government is doing it, private payers will follow I.E. United Healthcare

CHANGE HAS ARRIVED

PREPARATION IS KEY

•“Fire burning out of control in healthcare”

•Be proactive or not

•In 2019 rehab professionals required to report - MIPS

•demonstrate effectiveness of services to get paid

•outcomes will play a big part

•start aligning clinics and review performance of outcomes

•gets the kinks out, so get rewards, not penalties

•share the data within the company

SHIFT TO OUTCOME BASED PAYMENT• Alternative Payment Model

• 30% of Medicare payments already tied to APMs• 50% will be based on quality metrics by end of 2018• planning for 90% of remaining fee-for-service by end of 2018• focus is on quality, performance and outcomes

GETTING PAID WITH MIPS

• Presently participation is voluntary and in testing mode

• can get up to a 5% incentive payment now, but future will have penalties

• Depends on:

• providers starting quality assurance program

• collecting data

• monitor results/assessing outcomes to determine effectiveness

• increasing quality of care

APMS - THE FUTURE IS NOT JUST MEDICARE

• don't limit self to only Medicare based APMs

• by 2019 most likely have to qualify through an

all payer combination option

• wide range of value based/payment models out

there

• fee-for-service, per diem, or capitation

PAYMENT MODELS IN PLAY NOW AND FUTURE

• Shared Savings Model or Accountable Care

Organization (ACO)

• group of providers contracted with a payor

• parties agree on costs

• merges fee for service with incentives to

minimize spending

BUNDLED PAYMENT MODEL

• several types of services by different providers

• lump sum for entire episode of care

• working "together" to minimize the costs

• similar to capitation?

HYBRID MODEL• mix of fee-for-service and potential for performance based

• Common theme: outcomes will be considered in all

• Need quality care and cost savings to get paid

INSPIRE TO GET PAID• Common operational metrics used by companies to analyze:

• visits/referral

• units/visit

• cancel rates

• many clinicians DON’T really care about this

• New operational metrics:

• outcomes and data collection

• clinicians DO care about this, thus inspire them

• they want good patient outcomes, quality care, satisfaction

• this drives common metrics up, and it is what APMs want to see, thus gets you paid

IMPLEMENTATION

• Multiple ways to collect data• Kiosk in waiting room – links to chart• Email outcome measurement tools through 3rd party• Fill out on paper then we import manually

• Frequency determined by payor (CMS every 10th visit) or by organization

• WEBPT Outcomes simplifies process

• Must capture at IE and DC

WRAP-UP

• You need to know how you are doing so that you can always improve your game.

• Scoring breeds motivation

• Many pathways to market this data to drive referrals

• Huge impact to bring this information up during payor negotiation

• Pay For Performance models are coming and without outcomes data, you are out.

OUR OTHER PASSIONS (BEYOND PT OUTCOMES)

CONTACT INFORMATION

• Mike Manzo mmanzo@atlanticptcenter,com

• Instagram: @Atlantic_pt, @mikemanzo1, Twitter: @MmanzoMike, @AtlanticPT

• Mike Mundry mmundry@atlanticptcenter.com

RESOURCES

• 1.) Richardson WC, Berwick DM, Bisgard JC, et al. Crossing the Quality Chasm: A New Health System for the 21st Century. Available at: https://www.national acadamies.org/hmd. Accessed August 28. 2017

• Dolot, Janet HPA Resource, May 2016; 16(1): 4-4. 1p. (Article) ISSN: 1931-6313• Childs J, Harman J, Rodeghero, J, Horn M, George S. Impications of Practice Setting on Clinical

Outcomes and Efficiency of Care in the Delivery of Physical Therapy Services JOSPT, 2014:44(12): 955-963

• Garcia RK (2012) Functional Outcome Measures in Physiotherapy: Bridging Evidenced-Based Practice, Function, and out Future. J Nov Physiother 2:e106. doi: 10.4172/2165-7025.1000e106

• Chesbrough K, Crockett R, Elrod M, Moore J, Smith H, and Irrgang J. Physical Therapy Outcomes Registry: A Multi-Dimensional Data Clooection System. American Physical Therapy Association NEXT Annual Conference, 22 Jun 2017, Boston, MA.