Focusing on Outcomes in a Culture of Declining Reimbursement

Previously Recorded Webinar: A Director of Rehab Talks Candidly About Keeping the Focus on Outcomes (in the Face of Declining Reimbursement). Don’t worry, this conversation has a happy ending. It’s an interview with a fellow hospital rehab leader facing the same issues you are—and he’s finding success with some very specific tactics.

Hear Josh Drummond, Director of Rehabilitation Services at Missouri-based Ozarks Medical Center,discuss how his facilities are getting a jump on pay-for-performance by driving documentation to ensure the impact of declining reimbursements is mitigated as well as how he keeps his providers focused on patient outcomes.

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Transcript

– – [Brian] Well, good afternoon, everyone. My name is Brian Shivler, I am a Vice President with Net Health ReDoc. We are thrilled with the outcome of today’s webinar, we have over 100 people expected to join us today, many rehab leaders across the country, and we’ve got a couple of special guests that I’m very excited to spend some time talking with. I wanna take a moment to let you know kinda the premise for where this, this webinar came from. I was at ATTA and had the chance to talk with a lot of rehab leaders across the country. And as I was having those conversations, what really struck me was the fact that so many rehab leaders are feeling somewhat hopeless, caught in the world of trying to figure out how do you push forward without cons in productivity in the situation that we’re in today? And so we thought it would be wise for us to just spend a little time today together with a couple of therapists who spend their lives working in that environment. Just to let everyone know, we will spend a few minutes at the end of our time together answering questions, so if you’ve got any questions, you can submit those as we move through the webinar, and then if you have additional questions that come up after we finish, you can submit those to redoc@nethealth.com. And so, without further ado, let’s get moving and talk a little bit about what we have going on today. So, as I mentioned, as I was speaking with, with many of your colleagues, the thing that really struck me was everybody is feeling an increased pressure to hold and improve outcomes as resources continue to decline and expectations continue to escalate. And so you can see on your screen that there are just a few things, they’re broad categories but these are things that are really on leaders’ hearts across the country. MIPS and pay-for-performance, managing the episodes of care, and when it comes to the idea of growing the volume in your clinic, the how-tos to really become the obvious destination for rehab therapy in that region. And as I had the chance to speak to rehab leaders, these were things that are just burning on their hearts and so, as I mentioned, I’m thrilled to have the opportunity to just spend a little time with Doug Cundiff and Josh Drummond today, and we organized this webinar around the notion of hope, and we here at Net Health ReDoc, we have the privilege of working with some just awesome rehab leaders across the country and today we get a chance to talk with two of them. One is Doug Cundiff, who is responsible for Net Health ReDoc’s 360 Professional Services Team. Doug spends his life traveling around the country working with rehab leaders and clinics on helping them to understand best practice standards and really pushing the envelope for what new solutions can be brought to the table. And as a special guest, we have Josh Drummond, who is also a therapist. And Josh is a long time partner of Net Health ReDoc and I get the chance to talk with a lot of leaders and I would put Josh firmly in the category of being a shining example of leading well through a season of high change. And Josh’s team has been using our ReDoc Classic documentation software for years and has just moved to our new web-based xfit solution, so we’ll talk a little bit about that and what that’s meant to his team also. Josh, would you just take a moment and educate our audience about your responsibilities and kinda the purview that you oversee with regard to rehab at Ozarks?

– [Josh] So we are in south central Missouri, we’re a still privately-held network that I really would call much more than a hospital. We’re located throughout seven countries with real health clinics, urgent cares all over the place. Our rehab operation sort of spreads amidst that network as well. So, currently have six actual, kinda hard outpatient locations with a couple other, I kinda, laughing would call ’em half locations, we work in a couple other clinics with specialty practice as well, pediatrics and then our orthopedics office, we have a therapist who practices there. We also do outpatients at home and off-site locations, as well as all the extras. So we also run a huge peds department with, this year, we’re nineteen school-based contracts. We service and staff our home health agency as well as hospice. We operate inside the acute care facility here, we do some aquatic care off-site here in town. And then we have a couple other things as well, some other specialty contracts with skilled nursing and an industrial operation here in our area. We’ve just seen incredible growth in the last couple of years, it’s been really amazing. When I started with OMC four years ago, we were running 58 or so staff members and today we’re at almost 75. and ReDoc’s been a big part of that growth and being able to really, especially quantify it, and continue to be able to accommodate the volumes that we’re growing into with relative ease, anyway. I don’t know if my staff would say that, but I’m gonna say relative ease. So it’s been an incredible thing to be a part of this operation, and in my view, really able to maintain a lot of best practice standards that are becoming more and more difficult to uphold.

– [Brian] Remind me what HIS program your hospital system is using

– [Josh] Yes, the system is split right now. Primarily, Meditech, our clinics arm uses an Allscripts version, home health uses an Allscripts version. And there’s a number of other boutique softwares, but as far as ReDoc goes, we interact with Meditech and directly input into that system.

– [Brian] Okay, and you’ve got a fully integrated system, right? Fully integrated solution?

– [Josh] Yes, sir. Yep, fully integrated into Meditech. Everything we do lands there, Meditech is the true, legal electronic health record. And then as far as our input into that system, everything departmentally on an outpatient basis and all of our primary scheduling all happens from ReDoc

– [Brian] And Doug, I’m just gonna take a moment and, if you would, give us a handle on, I mean obviously you spend your life traveling around the country working with therapy leaders, so it gives you some insight that a lot of us don’t have, quite frankly. And just share for a moment what you’re seeing as people begin to look for best practice standards. And how do you promote those key performance indicators that define successful clinics? What are you seeing across the country?

– [Doug] Yeah, I have an opportunity, as you mentioned earlier, to work with and speak with directors and rehab leaders all across the country, whether it’s in person or remotely. You know, at times, they’re trying to make that decision on the EMR solution that’s gonna be their best fit. Or once our current clients are alive and up and going with our programs, it’s a full service solution, we had the opportunity to work with them post go live to help them achieve the goals that they’re striving for beyond a compliant documentation solution. So one of the first questions that I like to ask, and I enjoy the responses time over, is, I’ll ask the leaders, you know, at night, what’s keeping you up at night? Or what are the pressures or demands that are placed on you from your leadership if you’re in a hospital setting or by the owners in those private practices? And I’ll rattle off, you know, is it things like productivity and holding the staff accountable for that? And some don’t like that word, productivity, but efficiencies, right? Other leaders are looking for the data, the reports that are meaningful to them right now versus depending on other system or hospital reports. They wanna see that data right now, they don’t wanna lean on manual tracking. That balancing act between the therapist and patient scheduling, you know, the hours of operation, access, you know, finding that balance is an ongoing challenge. Having the support, budgetary-wise and resource-wise to go out and grow that business, you know, as you mentioned earlier, Brian, becoming that clear choice for rehab therapy in your area, you need to invest time to do that. And then certainly, really, about today and more so, now more than ever, is that, that focus on patient outcome, with the regulatory changes, the payer compliance, more and more. And I ask them, are these the types of things keeping you up at night? I get a resounding yes

– [Brian] So just, I’m very interested, so are these really your five pillars? I mean, are these the things that scope, when you’re working in a consultative scenario with directors around the country, are these the pillars that you guys are using to measure health and success of a clinic?

– [Doug] Absolutely, and I think we’ll have the opportunity to speak a little bit later in today’s discussion, but, you know, having that scorecard, having that dashboard and key moves, key initiatives to drive and address those are paramount, we have the data to do that. I would say, you know, nine out of ten times when I’m speaking with those rehab leaders, if I rattle these off, they’re not adding too many others. These fall right in line with what I’m hearing. And I’ll be anxious to hear from the audience today what else is keeping them up at night.

– [Brian] Yeah, and along those lines, Josh, maybe off script, maybe candidly, are you feeling the tension that Doug is seeing around the country when it comes to responding to payers and using outcomes in the face of declining reimbursement? Is that, is it something you guys are really living?

– [Josh] Absolutely, I think there’s no question. You know, I think whether it’s the rehab world, the physician side, this is something, if you’ve been in it very long, you’ve certainly heard the threats of people literally looking at every single document and saying, “Yeah, no, we’re not gonna pay you for that.” Unfortunately, you know, that has sort of hit at this point. It used to be, even three or four years ago, it was not really a reality quite yet. At this point, especially here in Missouri where I’m at, we have started having companies literally looking at each individual document and walking through and saying, “Okay, based on that document,” maybe it was three months ago, “We’ve decided that we’re no longer “gonna pay you for that episode “from that day forward.” And so we have been, really since last July, July of 17, we’ve been going through a number of dogfights on some of these topics and I jokingly kinda cringe every time I see one of our billing specialists walk into my office, and typically I’ll just turn my chair around away from her and try to hope she just leaves. So this definitely a reality, there’s no question about it. So, on the insurance level, we’re definitely seeing these issues and, although it’s not every company, we are seeing more and more companies be so stringent with their requirements that we really have no choice but to apply those standards across the board. So that’s definitely reality, and then beyond that, just in the organization as well. We’re reporting quality metrics out on a routine basis and we’re held accountable to those and the goals that we set in-house as well. And then, you know, just for the sake of our staff, we all wanna deliver absolutely the best quality of care. You know, when you do have somebody question the billing that you did for that day, you wanna feel confident in saying, “Yes, I did everything I needed to do that day for you “and I’m doing the best I can “to get you out of here as quickly as possible.” So I think those are things that definitely are on our minds constantly. And the idea of the value proposition that, Brian, you had on that earlier slide, I think that’s something, I kinda preach that to my staff on a routine basis. Ultimately, if you look at your patient and they ask you, “What am I gonna get for this? “What’s the value to me?” You really need to do something here each and every day that you feel like makes it worth that patient’s time. So beyond just the insurance side and all that, I wanna know that we are doing the right thing for people and that we’re doing everything we can to get them better on a day-by-day basis. And then bigger picture, the issue of our overall professions, the fact that we all would like to continue to make more money throughout time, and we know that the cost of education continues to be a problem. So when you really look out on the strategic landscape and when you look out at the future, those questions do, they kinda continue to haunt me, and all of us, I think. You don’t know what the model’s gonna look like in the next, you know, one or two or five or 10 years. And we know that expenses continue to rise, we know that reimbursement, at best, is stagnant, and we sure don’t see that looking too optimistic on getting some giant raise from insurers, right? So, yeah, these are definitely huge issues that are not hypothetical anymore, they are real on a day-by-day basis

– [Brian] Well thanks for sharing your heart. One of the things that I know I’m seeing as people are articulating it to me is in the traditional hospital setting, of a hospital owned or managed instead of clinics, in the past, outpatient rehab has kinda been looked at by many of the hospitals as something that has to be done. A quote unquote cost center. And naturally, when you’ve got so many large opportunities and expenses hanging over your head. One of the things that’s been just, you know, really has gotten my hope meter up is as I’m talking with many of the C-suite members in hospitals, in particular the CFOs, they have begun to recognize that you can have a fantastic clinical outcome coming out of the OR, but if your outpatient rehabilitation system doesn’t perform the way everybody’s anticipating, then the patient outcome, as well as patient satisfaction, is not going to be what anyone expects and that means, in some of the world today and right around the corner, in the future, it means declining payment. And so that notion of hope as CEOs and CFOs are articulating it to us in that they are open and willing to invest in outpatient rehabilitation maybe in ways they didn’t think about even last year or several years ago, it’s a compelling story and it, as you were just discussing, the future of rehabilitation. It just jogged my memory about that, and so that’s something that I think is quickly becoming a reality to many hospitals and we’re seeing lots more hospitals, you know, finance departments who are in the camp of we are going to need to use the HIS system we use no matter what. They’re opening their eyes and minds to other solutions which can really help maximize not just outcomes, but productivity. And it’s one thing to be able to talk about the fact that everybody’s experiencing these challenges as well as performance, but I think it’s a whole other thing to share with people how those things are actually being addressed, and so I wanna spend the balance of our time today, if that’s okay, just talking about how a lot of those key indicators are being addressed. So, Josh, would you mind just, just give us a sense for how has your staff, you know, how are they responding to this new level of accountability? And what metrics are you guys using currently in your scenario to look at what success is? What are those KPIs, those key performance indicators? And you can see that we’ve moved to a sample hospital and several of those KPIs. Would you mind sharing that with our audience?

– [Josh] Yeah, absolutely. I would say our staff, just like everyone else, we all continue to struggle through the idea that we know what a patient needs but are we allowed to provide that in the outpatient setting or any other setting for that matter? So those things are being challenged more and more every day, so. Yeah, I think we’re all struggling through some of those topics. For me, I wanna continue to, as a leader, challenge myself to put my staff in the best possible situation to be able to do that, to provide that value for their patient, to give them the knowledge that they need in doing so, but also to take the rest of it away as much as I can in order to put them in a position to just do their jobs well. And that comes back to productivity and efficiency. We use the efficiency word around here, I prefer it, but I need my therapist to be aware of those stats and they need to be aware of all kinds of other things, obviously, but at the end of the day, I wanna make sure we’re doing the right thing for the patient. And ultimately, engaged employees and satisfied patients are the two things that we need, no matter what, to keep this thing moving and keep it going well. So, in doing that, I started making a list of just stats that we watch and track, and it’s a big difference between the things, obviously, that I keep an eye on and occasionally share with my staff versus the things that we really use on a day-in and day-out basis with them. But just a gloss over the things that we watch on a bigger level, biweekly productivities, of course. No matter how good or bad things are going, that ultimately is the one that we here are held accountable to with our senior leadership, so if we’re looking good on the biweekly productivity levels I know that I can kinda keep moving and feel pretty comfortable with what I’m doing. When those numbers drop, you know that you gotta be looking at those very closely and very quickly. So that’s sort of a key driver here. Beyond that, though, I watch referral numbers, I watch units per referral, expense per unit, obviously the overall financials with overall net margin, our expenses, supply expense levels, continuing to watch those closely. I know our organization on the bigger picture is doing, so. We look at trended data and tryna sort of watch, you know, maybe three years ago, and even 2 1/2 years ago, we were seeing sort of a scary trend in a slow decline in our overall outpatient utilization. We’re seeing this giant jump in school and pediatric use, but watching those trends has really been good for me to be able to cue our staff and watch where we’re moving and those kinda things, and now we’re really seeing that number bump over the last 18 months or so, moving in a much happier direction for me. On the department level, we also use a whole bunch of stuff. So we use FOTO in association with ReDoc. So with those FOTO stats, we watch patient satisfaction numbers very closely, that’s part of what we report out to our quality board. Likelihood for the patients to refer, overall results of the therapy, courtesy and respect, and then we have some access metrics that we watch as well through FOTO with access to facility and overall availability of appointments. And then we do look at the actual functional scale improvements as well as what you see on your screen, the utilization, effectiveness and efficiency. So we use those numbers in concert, we talk to therapists about those, typically send out the overall stats and the unique therapist stats on a monthly basis, and then we use those in our goal setting and performance management meetings, excuse me, on a quarterly basis. And then we also have them sort of set up in our productivity tracking system to be able to see some more daily detail, and honestly, they tend to beat themselves up a lot more on their overall productivity and efficiency a lot more than I do. So we do have them looking at their overall percentage of productivity, of course, units per billable hour, cancellation percentage is a big one obviously for us and a lot of people, that’s something we focus on and we’re currently performing exceptionally well on that, especially given how high our pediatric volumes are. So a lot of stuff there, and ultimately, I look at different pieces at different times, the quality metrics are huge, and of course, we’re reporting those things out. But in terms of what I really use with the therapists on a day-by-day or a month-by-month basis, those key indicators for them are a little bit more honed in, a little bit more specific and we’ve seen really nice results with focusing in on what metrics are keys for us, specifically addressing those with the therapists and saying, “Hey, I don’t wanna beat you to death on this “but you should know this is something “that we’re sagging in.” You know, “These results correlate with this outcome.” And, you know, “Watch this for me, see what you think.” And with sort of a gentle, I would say sort of shepherding based on that data, we have really seen nice improvement especially over the last 12 months.

– [Brian] Josh, just real quick one, Doug, I wanna get your opinion on something too. It’s really inspiring to me because as you’re moving these markers forward and you’re educating your colleagues and staff about the importance of all of them working in conjunction toward the patient outcome, I think what really resonates with me in your leadership style is, you know, I’ve heard you say, the thing that matters the most is the time with patients. So everything needs to point toward maximizing our therapists’ time with patients, and if we’re, if that’s the end result in all these other coordinates then we know we’re doing something right. So, I appreciate that and I think it’s important for our audience to know that’s your thought. And, Doug, what are you seeing around the rest of the country? Josh is clearly seeing that the importance of outcomes are beginning to affect, somewhat profoundly, his financial success. How are people tracking these indicators and pay-for-performance? Is it a reality nationally? Or is it just still in pockets? Give us your take on that.

– [Doug] Yeah, sure. And I just wanna highlight one thing that Josh shared too, is, and in having the opportunity to work with him, is he truly does treat his staff, his department as professionals. So that accountability is inherited by his leadership style and I’ve seen, that is very effective and goes a long way. You know, we are recognizing more and more that, you know, we need to help the entire staff, the therapists, the support team, front office to see the big picture. Tracking patient outcomes is not new, we all learned about a number of tools and opportunities to do so. And I’ve seen, over the years, varying degrees in which the outcomes were tracked and used to take action on. But now we’re seeing that and we’re tasked with getting the best patient outcome at the best value, and payers are asking for this information so that we can get paid. And so the reality is here now, it’s not coming, it’s here. So in turn, I see more departments, more therapists spending time with the patients, making sure that they understand their role in their recovery, in their plan of care as well. Attending the scheduled appointments and rescheduling when you can’t make it, compliance with the home exercise programs, that shared accountability is important for sure. And we also see some creativity with the way we’re managing, communicating and working with patients between visits. I attended a conference not too long ago and one of the presenters was talking about a patient who was going a vacation, they were pretty well into their recovery, in fact, they were doing a little bit of a hike, but they had planned three Skype meetings over a two week period to make sure that what the patient had been working on and was trying to get back to, what their long-term goals were, they had regular touch points that were going to help the therapist, help the patient ensure that they were staying on task. They gave themselves the ability to adapt on the fly as needed. And that creativity, as we see the way we’re getting paid change and is it per procedure? Is it per visit? Is it per episode? At the end of the day, we need to make sure that the care we’re providing is yielding the outcome that we need, not just for the patient, but to get paid. So, you know, are we prepared for the future? The mindset’s there for sure, and the tools are now available for us and we just gotta stay creative in the way we manage that patient through the episode and beyond.

– [Brian] Well, I would agree, I’m seeing the same thing and I saw a staggering number the other day, it was in excess of 75% of patients in the outpatient therapy market discharge themselves before the plan of care is fulfilled. And so I now how hard today, as therapists, we’re working to get the insurance companies and the payers to authorize those visits and, you know, you mentioning, as did Josh, the importance of educating the patient as to how far they’ve come with their progress and what’s expected still I think is a key to keeping them in the game, so thanks for sharing that. Josh, would you just take a moment as we’re beginning to close our time together, if, you know, for your rehab colleagues across the country who are listening and, you know, may hear this later, what pearls of wisdom can you give them about moving ahead and really using outcomes to drive success? What are the couple of key things that come to mind?

– [Josh] Yeah, I think a couple of things that we already talked about. But the value proposition to me is a huge thing to work on with staff, just making sure that your therapists appreciate and understand the degree to which that client is, or patient, or however you call ’em, but ultimately, that person is a customer and we need them to come choose us and we need ’em to come back ’cause it’s worth their time and it’s worth the energy, and not just because they had an order to come see us. So we really talk a lot about value proposition and trying to make sure that we keep that in focus. Connect with your patients, you know, ultimately, that too is just such a big deal at this point in history. You know, I know in practices where volume requirements are higher, it’s harder to do that. But I have worked places that struggled with that because of the pace at which they’re moving, how many different clinicians a person might see, whatever. But ultimately, making sure that we deliver the quality that we would expect as a patient is a big thing for us, and it’s something that we all struggle with, and I think we’re in a better situation to generally provide that, and I know we still struggle with it. So those are things we talk about on a routine basis. Engaging the team and trying to make sure that whatever’s going on, we have them generally educated on the issue and try to use a little bit of a bridge between, you know, what the administration expectations are and what the therapist actually needs to do, you know. We shield them at times, we have to get on them a bit at times, but ultimately, working with them as a team is the way that we kinda get there. And you mentioned this before but when I interview anybody, I say, “I really need you to come, “and I need you to be a pro.” I’m not a micromanager, I can’t be, I don’t have time. Ultimately, I need you to be a professional and I wanna empower you to go be a pro. And I wanna help you come back to me with needs, I wanna talk to you, I wanna see you all the time, that’s great. But ultimately, I wanna empower you to go be who you went to school to be. Go be a professional, go be the therapist that you know you can be and I’ll help you get there, I’ll remove barriers as I can but those are some of the things that we routinely work on and try to keep in focus. – [Brian] Thanks for that wisdom. Doug, give us your sense for how you’re helping our partners define what are comprehensive outcomes? – [Doug] Yeah, we certainly spend a lot of time up front, when one of our partners, one of our clients decides to move forward with ReDoc, certainly the training, the implementation of the software program itself and ensuring that everyone can smoothly navigate through the documentation workflow, that’s our early focus. What I enjoy doing post go live is, we have, again, a number of reports, a lot of data that we wanna make sure that there’s a cadence in place that enables our directors, superusers, managers and so on, you know, what are the reports that need to be looked at daily, weekly and monthly that drive the good patient outcome, the good financial outcome? There’s a number of reports and a delivered approach that we wanna make sure that all of our partners take. You know, identifying things like patients at risk of self-discharge. You know, through paying attention to patient attendance, your access, treatment and activity where a patient hasn’t been seen or documented on in seven or 14 days. We help our partners narrow in on some of the dashboard, the data elements that help them identify what’s important to them. And we learned this by starting with a scorecard. When we’re working with our clients or partners, we’ll go through a series of questions that ask questions that are best or leading practice in nature that are gonna drive that best patient outcome, again, whether it’s patient satisfaction, operational or clinical. We’ll ask best practice questions around that category, around financial performance, and then visit management and growth so that we learn and understand not what we think is important for them but what’s pressing? What’s most important for them right now? Where do they wanna focus on? And then at the end of the day, as we’re talking about today, we need to make sure that the patient outcomes, that the patient involvement in setting the goals, working on the plan of care, the visit frequency, that there is buy in that the plan that we work on together is gonna yield the outcome that the patient wants. And for those of you using FOTO, or if you’re not aware, there’s a lot of good information when a patient completes that survey, and one of the things that we’re stressing more than ever is that this is a risk-adjusted database so that when a patient completes that information for their clinical presentation, it’s gonna give a lot of information about clients, or patients in a similar clinical presentation and what their outcomes were to predict it in nature. So when it predicts that patients similar to you, it took 12 or it took 14 minutes to get from point A to point B improvements, that’s important to share with the patient, because you’re working with the patient on visit frequency and expectations. And we know now, more than ever, with more and more out-of-pocket costs being handed to the patients that there’s a lot of expense that could be involved with any healthcare, especially outpatient therapy, with the copays and the deductibles. And we also know that patients will invest in things that are important to them. So if we spend the time up front with patients showing them the data of like patients, and here’s what we’re predicting, let’s agree on this plan of care, and then throughout that episode, show them the progress they’re making. Or, if we’re not making the progress, we need to change the treatment frequency up a little bit, we can do so. But if the patients see where they are, where they can get to and the progress they’re making along the way, they’re going to invest in that care and those out-of-pockets and that deductible, and it’s gonna help all of us get that outcome that we need. Josh, do you have anything to add to that? I know you have a very deliberate plan in place using the outcomes and using the metrics, but did I touch base for you? Similar practices or anything to add to that?

– [Brian] Yeah, and this is Brian. Josh, just before you, you jump into that, if you would just, while you’re addressing Doug’s question, could you just share with your colleagues, you know, you guys mentioned how much you’re using FOTO, could you share with everyone, you know, operationally, how does it actually work when you’re collecting outcomes through FOTO?

– [Josh] Doug hit it really well, and I would just echo what he said by saying that pre-ReDoc and pre-FOTO, and this is not intended to be a sales plug at all, I’m not getting paid for this, unless you guys just decide to but, we have struggled in the past so badly. When I started working here, just in Meditech, we had no data. We were driving at midnight with no headlights in the fog. I mean, it was bad. So this was just, it’s so enlightening to get department and really practice-specific data at this level, and then you add FOTO into it, and we had some outcome data before, but it wasn’t integrated well, it wasn’t utilized well, and just getting therapists to use it was hard. So anyway, this data has been invaluable to us, and we use it routinely. So FOTO is captured on every patient that qualifies, we’ve coached the therapists to use that data, show it to the patient, talk ’em through it, see if the results make sense, and if they don’t, let’s discuss why. And that’s created a lot of good healthy conversation too. And then we’ve been able to use that data and say, hey, guys, this metric looks a little saggy and we’d like to talk about, why do you think that is? And okay, as a group, we just sort of know this, and I’m not asking you to necessarily do anything different at this moment, but what happened is we talked about that for a couple of months, and we started seeing those numbers come up. So it’s been really healthy for us to be able to have good conversations, even if it’s a therapist having some negative perception about a result that doesn’t make sense, or a patient who, would assume, would not have been able to interact with the tablet or had some other, you know, difficulty or reason why FOTO didn’t make sense to them. We echo FOTO in that when the therapist shows value in the system and the data, the patient finds value in it too, and we really, it took several months, don’t get me wrong, but after, you know, probably two quarters of data coming along, we started to feel better and better about the system and feel better and better about our implementation, and then being able to actually use it with intent. And we’ve started using it now and not just on the satisfaction stuff, but also in the actual functional skill changes for goal setting for the individual therapists as well. So everybody’s using the system well, our completion percentage is excellent, in my opinion, in the 80s right now, so it’s a system we have enjoyed and I think it provides really valuable data that you can manage off of and that therapists appreciate.

– [Brian] Well, I certainly appreciate that perspective. We are getting along time, maybe just time to answer one question. Other questions, if you haven’t submitted them yet, you can feel free to submit them to redoc@nethealth.com and we will get someone to get back to you who is tied into this information, maybe Doug or Josh. Just, if you would, Josh, are you using FOTO to, with payers yet? Or referring physicians to promote your clinics and your outcomes? Have you gone that far yet? Are you comfortable enough with the data?

– [Josh] We’re using satisfaction all over the place. We are not yet using the actual function skill changes outside of in-house and then also with, directly with our patients. But I certainly see a day where that’s coming, no question about it.

– [Brian] Well, in closing, I just wanna mention, we have, in working with clinics all over the country, a tremendous amount of information that we have really started to aggregate here at Net Health ReDoc to look at best practice standards for many of the KPIs that we looked at today, and we’re posting those online, and, as I mentioned, it’s one thing to show somebody a best practice standard and any particular key performance indicator, whether it’s, you know, clinical outcomes, patient satisfaction, visits per therapist per day, visits per referral, whatever you happen to be counting, it’s another thing to be able to share with people across the country how those best practice standards are being achieved, and today was one of our first steps in beginning to promote that idea. And so we’re looking forward to, to many more webinars of this nature where we can pick topics that are burning on people’s minds and hearts. And so, if you’re interested in any of that, don’t hesitate to reach out at redoc@nethealth.com and we will connect you with any one of those media sources or a person that can walk through any of the challenges with you that you’re having. So with that, we’ll close our time together. Mr Cundiff, Josh, we are just so thrilled with you guys for being with us today and sharing your hearts, and leading through what is truly a high season of change.