The first important step for evaluating your services is determining what you want to evaluate. After you determine this, you need a system to capture the necessary data to allow you to analyze the results to make a final evaluation.
Surprisingly, there are three types of evaluation options. Each type of evaluation is unique to the type of information required to judge the results.
- Goals-based Evaluation: Let’s say your organization decides to implement peak-end theory with every patient encounter. The goals for your department are to reduce the no show rate to 6% or less, to increase word of mouth referrals to 45% and to increase satisfaction to a consistent 98% or better on average. These goals are to be met within 6 months of implementation and maintained for another 6 months.
I assume the majority of electronic medical records will be a data source for this particular example. I know that I am able to pull reports from TheraOffice, my electronic medical record, to provide me the no show rate and word of mouth referrals. I know that I am able to pull satisfaction data from FOTO.
- Process-based Evaluation: Although this type of evaluation does not immediately seem to be relevant to evaluating service, it has merit. Let’s pretend that your organization has begun having a substantial increase in Medicare denials. The reason for the denials is because functional limitation codes and modifiers are not being included on claims. The types of questions you’ll be asking revolve around processes within the organization.
- Are patients completing patient reported outcomes at the appropriate times?
- What reminders or tasks have been created to ensure patients complete the measures?
- Are staff adequately trained to retrieve reminders or tasks?
- Are all clinicians in the organization negligent in including the codes and modifiers on claims?
- Is there a way for front office personnel to be involved in ensuring each patient completes outcome measures?
- When is the denial occurring: initial, 10th visit/30-day point in time or discharge?
- After a patient completes an outcome measure, how are the functional limitation codes and modifiers determined?
As you can see, a process-based evaluation feels more qualitative in nature. It focuses on who, what, when, and how. In a process-based evaluation the focus is mapping out a process and determining how well the process is working or where the process breaks down leading to failure. When the problem is identified, the goal is to change the process.
- Outcome-based Evaluation: This type of evaluation answers the question, “are my services making a difference in the lives of my customers?” In the rehabilitation world, one of the best ways to determine this is to learn how much functional change happens as a result of your services. To most accurately know, you need a system that risk adjusts for patient factors that affect outcomes.
- Do you capture level of function prior to beginning services?
- Does your system risk adjust?
- As a bonus feature, do you have a system that can predict the final outcome?
- Do you capture level of function prior to discontinuing an episode of care?
- Does your system have the capability for benchmark reporting?
An outcome-based evaluation will focus on what functional change happens in your patients lives. A great system will combine both the effectiveness and efficiency of your services. Outcome-based evaluations are key in the ever-changing health care environment. When the predominant fee-for-service payment model changes toward a value based payment model, you will need to perform outcome-based evaluations at least quarterly.
If you are looking for a product to assist you with outcomes-based evaluations, look no further. Please talk to Judy Holder or Julie Emerick about how FOTO can help.
Until next time,