By Doug Cundiff, MPT, MPH, VP, ReDoc 360 Professional Services
The shift toward value-based reimbursement is gaining steam. The Centers for Medicare and Medicaid Services Merit-Based Incentive Program (MIPS) is in its third year with high and increasing rates of participation. Large commercial payers are following suit with initiatives that include a greater emphasis on patient outcomes.
In the rehab industry, we can always do better tracking and monitoring patient outcomes. Not only will this prepare us in light of current industry trends, but it can help deliver a better patient experience, streamline our operations, and drive word of mouth referrals.
What is MIPS and How Does it Impact My Practice?
MIPS is part of the Quality Payment Program that began in 2017. Participating providers are scored based on four performance categories—Quality, Promoting Interoperability (PI), Improvement Activities (IA), and Cost. Physical and occupational therapists and speech-language pathologists became eligible to participate in 2019, but so far, they are only required to report data for the Quality and IA categories.
The total score drawn from these four categories is helpful to gauge performance, but it serves a much bigger purpose. Starting with the 2020 MIPS performance year (2022 payment year), participants will receive between a +9% and a -9% payment adjustment to Medicare Part B claims based on their scores. In other words, do a great job and get rewarded with higher reimbursements. On the other side, though, when we miss the mark, it could mean a negative payment adjustment.
While it’s easy to focus on the potential negative here, a better approach is to see the possible upside for providers with great patient outcomes. It’s a unique and exciting opportunity to get extra compensation for doing what we do best—offering great service and delivering quality patient outcomes.
How Will Patient Outcomes Affect My Therapy Business?
When it comes to building and reinforcing a therapy business’s competitive advantages, we’ve got a lot of options to pull away from the pack. Some effective areas of focus include things like hours of operation, the availability of specialty treatment programs, and telehealth.
But if we’re really looking to stand out a cut above the rest, having strong patient outcomes that are encouraging, measurable, and easily marketable to consumers and referral sources is important.
There are a multitude of different ways to approach the broad topic of patient outcomes. Generally, I recommend looking at three different areas that work in chorus to drive results.
3 Types of Outcomes and Why They’re Valuable
1. Clinical/Functional Outcomes
When we refer to patient outcomes, we generally think clinical and functional outcomes—things like changes in range of motion, strength, functional activities, and even the patient’s ability to do simple tasks that were once easy.
And while we do measure these things, there is a lot of value that comes from a mindset shift in how we choose to process and present the data.
Patient-reported outcomes of function can be used to benchmark successes against the rest of the country and identify areas for improvement. With supportive programs like Focus On Therapeutic Outcomes (FOTO), an outcomes management software solution for rehab therapists, access to a robust database, and risk-adjusted results helps us to see just how our departments as a whole or individual therapists are doing to deliver results.
Not only does this help us to improve our processes and celebrate growth, but payers are certainly looking at this data, which is an added incentive for optimal performance.
Additionally, these outcomes create opportunities to build raving fans out of our patients by demonstrating just how far they’ve come through the episode. When we can clearly show patients in a well-organized, easy-to-digest manner the measurable benefits of the treatment delivered, it’s a win-win for everybody.
2. Operational Outcomes
The smoother and more efficient internal operations run, the better the results and experience patients will see. Truly understanding the inner-workings, strengths, and weaknesses of a therapy business is best achieved by looking at operational outcomes.
For example, how successful and streamlined is the scheduling process? Can we get someone in for a new patient evaluation within 24-48 hours to mitigate the risks of them booking an appointment with us but then going somewhere else? Do we have an appointment reminder system? Is there a program in place for educating patients on how the scheduling process works? What’s the process for handling compliance challenges like no-call-no-shows?
Appointment slots are valuable to our operations, our therapists, and even other patients. But scheduling is just the beginning of looking at operational outcomes. Other areas of the therapy business we can evaluate include things like chart audits and compliance, documentation of care, and tracking insurance authorizations to ensure we’re offering the right level of treatment to mitigate reimbursement denials or delays in payment.
3. Patient Engagement and Satisfaction
All of the aforementioned outcomes boil down to one common goal—successfully engaging with our patients and driving the highest level of satisfaction. Our teams work hard to deliver results for patients. Making sure patients are understanding their satisfaction and taking note of how we go above and beyond is important. The goal is to create raving fans and not just satisfied customers.
One way we can do this is by educating staff on how to capitalize on deliberate processes. For example, let’s say you work hard to make sure that your patients are always brought back from the waiting room within five minutes of their scheduled appointment. If the customer makes a comment about this, it’s an opportunity to engage.
Instead of letting the customer believe that they’ve just been lucky with optimal appointment times, educate staff on how to let the patient know that’s something that’s done on purpose. Instead of, “Thanks,” they could say something like, “Thanks, we work really hard to schedule patients properly, and we have a policy in place that you aren’t going to wait more than five minutes past your appointment time.”
Not only does this reinforce the customer’s perception by building on operational successes, but it breeds someone who will recommend us to their friends, family, and coworkers.
What Do I Need To Do To Drive Patient Outcomes?
As directors or facility owners, we have many key performance indicators (KPIs) that we regularly track. To help take a therapy business to the next level, it can be beneficial to consider adding patient outcomes to the overall dashboard. Here are a few actionable steps to drive patient outcomes:
- Secure buy-in through education with therapists. Before implementing changes, educate the team on the why. Why are these things important, and what value does it bring to the table?
- Set baselines and goals for each KPI, including patient outcome metrics. Figure out where you’re at now and clearly define where you want to be in 1 month, 6 months, 12 months, etc.
- Clarify definitions for each metric and ensure the methodology for tracking results has solid data integrity. Data-driven decisions are only as good as the data. Make sure to measure metrics in a way that ensures the preservation of the data’s value.
- Provide the tools that will drive and support success. Equip the team with the tools and resources they need to succeed. For example, appointment reminders can help drive patient attendance, or FOTO can help move the needle with clinical and functional outcomes.
- Capitalize on opportunities to reinforce the positive results of deliberate policies and operational wins. Educate staff on how to respond when patients make a comment about something you’re doing right on purpose. These are ideal opportunities to capitalize on previous wins.
- Internally, share results frequently—set goals and recognize and celebrate success. By regularly measuring and sharing the data with the team, it continues to reinforce the buy-in and foster a collective team effort forward. When the team can clearly see the fruits of their labor, it’s a recipe for success.
Learn how Net Health Therapy for Hospital Outpatient Clinics (ReDoc® by xfit®) in conjunction with FOTO can help you define, quantify and leverage patient outcomes
About Doug Cundiff, MPT, MPH
Doug is currently VP of Net Health 360, Rehab Therapy. Responsibilities include helping clients leverage the features and benefits of the Net Health Therapy solution to demonstrate a balance of optimal financial performance and efficiencies with strong patient outcomes. By adopting this philosophy, outpatient therapy clinics become the clear choice for rehab therapy to their consumers, payers, and referral sources. Prior to joining Net Health, Doug spent the past fourteen years with an orthopedic service line development company conducting strategic assessments and implementing best practice programs. Doug also has a clinical background as a physical therapist and over seven years of direct experience with a musculoskeletal service line organization for a large academic tertiary care hospital system.