Reposted with permission from Frank Long and Physical Therapy Products
Therapists can reduce the time they spend on paperwork and increase the time they spend with patients by using electronic patient-reported outcomes measures (PROM). These measures offer powerful reporting that can be helpful in planning treatment, elevating patient satisfaction and improving reimbursement. Despite the availability of electronic PROMs, though, more than half of clinicians who responded to a 2019 survey conducted by the American Physical Therapy Association (APTA) indicated they capture PROMs data by using paper forms that are cumbersome and sometimes inaccurate.
To understand what facilities miss by continuing to use paper surveys, three physical therapists explain how FOTO’s Outcomes Manager, an outcomes management system that measures and manages patient-reported data, helps generate PROMs that improve their clinical care and financial positions.
Who doesn’t use PROMs?
While most therapists use PROMs, there still remains a large segment of practitioners who don’t take advantage of this important clinical tool. In fact, only about 60% of physical therapists use PROMs during routine clinical practice, according to Mark Werneke, PT, MS, Dip. MDT, a member of the research board for FOTO. While that figure represents a majority of therapists within that group, Werneke notes approximately 50% capture PROMs data using paper surveys.
The problem with those paper surveys, Werneke explains, is the burden they place on patients and therapists. For therapists, he says, the burden is significant enough that it has become one reason many refuse to administer PROM surveys during everyday practice.
“Among therapists, that increased burden is felt in the length of time it takes to score and analyze the survey data, then manually record that data in the electronic medical record (EMR),” Werneke says.
The cumbersome nature of paper surveys may be felt throughout the entire office, according to Michelle Young, PT, OCS, Cert. MDT, Team Leader at Valley Health Systems, Winchester, Va. Young says most healthcare organizations now use EMRs that require paper surveys to be scanned in order to be added to the record, thereby creating additional work for the front desk.
Fortunately FOTO’s Outcomes Manager provides an electronic means of capturing PROMs data that is fast, efficient, reduces or eliminates the cost for printer ink and paper, and is compatible with many practice management software systems.
Speed it up with computer-adaptive testing
One of the technologies FOTO’s Outcomes Manager uses to reduce the time therapists and patients spend on paperwork is Computer Adaptive Testing (CAT). Werneke explains that CAT is a method of scoring and collecting PROM data in which the computer tailors physical activity questions to the patient by matching the difficult level of that question to the patient’s direct ability. Because CAT minimizes the number of assessment questions asked without increasing PROM measurement error, the burden experienced by patients and therapists is reduced while the precision of PROM measurement is maintained.
Compared to old-style paper surveys that require a clinician to read a document that may contain 20-30 questions asking about a patient’s specific condition, CAT significantly improves the accuracy and efficiency of the data the assessment provides, according to J.W. Matheson, PT, DPT, SCS, CSCS, owner and clinical director of Catalyst Sports Medicine, Hudson, Wis.
“Clinicians can receive detailed insight about where a patient lies across functional levels or stages,” Matheson says. “Also, using a CAT provides therapists with fine-tuned answers using fewer test items, since patients are only tested with the question volume as necessary to prove where they are functionally,” he adds.
How much time can this technology save? For practices that have CAT and use FOTO’s Outcomes Manager, Young says, seven minutes is the average time a patient needs to complete the PROM.
Despite the availability of electronic PROMs, though, more than half of clinicians who responded to a 2019 survey conducted by the American Physical Therapy Association (APTA) indicated they capture PROMs data by using paper forms that are cumbersome and sometimes inaccurate.
Risk adjustment: apples to apples
Rehab patients must necessarily be associated with certain categories or classifications based on age, presentation, comorbidities and other factors that can muddy the waters when it comes to judging the quality of care. Risk adjustment levels the playing field so that therapists who treat more difficult patients are not penalized for non-modifiable factors.
Young offers an example of how this can have a positive effect on payer reimbursement:
“Clinic A is a sports medicine clinic treating a knee replacement patient who is relatively healthy. Clinic B is a hospital-based outpatient clinic treating a Medicaid patient who also had a knee replacement, along with six or seven co-morbidities.
“When each facility does its intake on FOTO’s Outcomes Manager, the therapist gets a prediction related to all of the patient’s risk-adjustment categories. This creates a statistically level playing field in terms of prediction and outcome between Clinic A and Clinic B by adjusting for the factors that create risk between those two different patients. It compares apples to apples,” Young explains.
This is particularly important in a pay-for-performance scenario, Young says, because it allows clinics and their performance to be compared across categories.
Changes in healthcare occur at a rapid pace that can make it easy for practices to be left behind. However, using FOTO’s Outcomes Manager to underwrite clinical efficiency and patient satisfaction can help practices adjust their behaviors to thrive and remain competitive in a changing marketplace.