FOTO Rehab Outcomes

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Selena Horner

I believe outcomes data is the new frontier - so many things to learn from this type of data: professionally, clinically and businessly!
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Aug 28, 2017 | Selena Horner

Payment for Value is Here to Stay

Christopher Khoury eloquently states, "payment for value and the associated tools, methods, and models that relate to that broad category will be here to stay."

In a recent interview, Christopher Khoury shares his insight about the healthcare environment. I tend to look outside the rehabilitation industry to gain various perspectives about current trends.  As we have been noting for the last few years, the trend in care revolves around quality. It is no longer acceptable to believe every clinician provides quality. In fact, it is now common place to have measurement systems in place and part of the every day work flow. 

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Aug 27, 2017 | Selena Horner

Revamping Value Based Payment

I love this quote from Charles Kahn. "The refocus begins with targeting measurement to capture what matters most, minimizing burden, and adapting to a transforming delivery system that strives to clinically integrate care."

Recently Charles Kahn wrote in the Health Affairs Blog about reexamining and refocusing  efforts on value-based payment models.  I'm sure all of us in the rehabilitation world whole-heartedly agree. For years, all we've reported are codes and modifiers that have no meaning or relevance about what matters to the patient from a rehabilitation perspective. All we've been doing is reporting to comply.

The mandatory functional limitation reporting has many problems. There is no value in the data. One reason, unless a clinician is using something like FOTO, there will be little to no consistency determining the anticipated discharge goal. Every clinician can guess or hope what the final discharge level of function will be. Our brains aren't capable of quantifying our clinical experiences which means relying on our memories will result in substantial inconsistencies. Another very huge reason the data will be horrible is because almost every patient reported outcome measure and performance measure has been converted to some level of percent disability. The psychometric properties and the design of some of the measures have nothing to do with functional ability.  We've unscientifically altered what some measurements measure. Can you guess another reason? The reporting does not include a risk adjustment process. Although functional limitation reporting is focused on the individual patient, stakeholders will not be analyzing n=1. Stakeholders will be analyzing and basing conclusions on aggregated data. The aggregated data will be used to determine the level of care clinicians or organizations provide.

What matters to patients? There are plenty of things that probably matter.  Bottom line: they want clinicians who care and those they 

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Aug 24, 2017 | Selena Horner

Association of Practice-Level Social and Medical Risk With Performance

Do you believe most of your patients are simple with little to no factors affecting the outcome of the care you provide? 

In a previous post I brought up the concept of social determinants of health.  A recent study looked at whether social determinants of health, medical factors or a combination of both would have an effect on incentive payments and penalties for practices.

After reading the abstract, I have an even better appreciation for what FOTO is able to do for clinicians and organizations with its risk adjustment process.  If risk is not accounted for in a value based payment model, then truly earned bonuses may not be earned OR undeserved penalties may occur.  Most of the current alternative payment models aren't really including a provision acknowledging risk adjustment or the importance of risk adjustment. Risk adjusted outcomes are key for a successful alternative payment model.

A favorable component within FOTO is a strong risk adjustment process coupled with predictive analytics. It's almost like having artificial intelligence onboard immediately at the start of an episode of care.  The next level of power within the system is analyzing data. The data revolves around the initial assessment, the predicted outcome and the final outcome. The final analysis using aggregated data determines the effectiveness and efficiency of the care provided.

If you take a look at the abstract, you'll see what can happen when a  payment model is based on raw data. The authors make a valid point that patients aren't all the same and that the payment models do not adequately address the patient risk factors.

Below you will find a quick view of the abstract.

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Aug 21, 2017 | Selena Horner

Low Dose Radiation Therapy for Musculoskeletal Problems

After I read the abstract I was cringing. Believe me, I think it is great to dream and have ideas. 

When it comes to a potentially new treatment, I would prefer if there is a control group. How do we know if radiation therapy is better? This abstract doesn't mention any complications or side effects.  With what was reported as the results, it seems we could toss a coin with regard to whether long term pain relief will occur. 

Below you will find a quick view of the abstract.

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Aug 17, 2017 | Selena Horner

Safety of Exercise for Patients who Have Advanced Cancer

This topic brings many memories to the forefront and is difficult for me. Years ago, I found a study by Andrea Cheville, MD highlighting the importance of exercise for these individuals. The study included a home exercise program. As I analyzed the program, it was quite apparent that the exercises were not strenuous.

Over the course of the last 2 years, I have had more and more patients who have cancer. For me is difficult to use FOTO with these individuals because they typically do not meet the predicted goals. The reason they do not meet the prediction is because they are outliers. They are outliers because the likelihood of attaining full, predicted function is not realistic. (Okay, I have nothing to substantiate this except what I have reflected on as I treat these individuals.) They are undergoing chemotherapy and infusions... they have bouts of hospitalization... they are experiencing side effects of their treatments...  they have periods where they are not able to physically attend. FOTO can track their change in function nicely - it tends to take longer for change to happen. Often their function reaches a plateau. 

Now, FOTO does have something of high value to help capture something that is really, really important for these individuals: fatigue level. Most of my patients are seeking an increase in strength so they can go up and down stairs normally and enough endurance so they can walk in the grocery store to get their groceries. They complain of severe fatigue. What I tend to use in FOTO as an optional survey is the Facit Fatigue Scale Version 4.  Often times, within 4-6 weeks of initiating services with me, the Facit Fatigue Scale has a substantial change.

I agree with the below study that we really do need more studies to assist us in designing exercise programs that are of the appropriate intensity for these individuals. For now, if you are lucky enough to use FOTO, you can track how they are changing.

Below you will find a quick view of the abstract.

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Aug 14, 2017 | Selena Horner

Does Treadmill Training Improve Gait in Individuals Post-Stroke?

My thoughts are very different than what you'll see in the abstract. What kind of treadmill was used for the experimental arm?

The reason that I ask is because I have a treadmill with GaitSens 2000.  (I am not being paid to mention this product. I truly do use it in the clinic with a variety of patients.) The really cool thing about combining force platform technology with a treadmill is the capability for me to really track changes. The other aspect that is awesome is the immediate feedback a patient receives when reaching goals that I set to improve their quality of gait. The immediate feedback is far faster than I can speak. (And if you know me, that is a feat in and of itself.)  The other neat thing is that with goals, the auditory cues when goals are met and with repetition, the patient's gait actually changes when walking in the clinic. With patients who have a neurological condition, the gait characteristics may not be perfect, but I can readily prove the changes via session reports. 

The other aspect to consider... typically, when a patient is walking on the treadmill, the person is holding onto the side rails. Well, from what I have seen, the gait characteristics on the floor don't tend to change as much until I begin having the patient let go of the side rails and walk. Yes, it is quite stumbly and unsteady and scary for the patient. The timing of movement patterns is not conducive to smooth, coordinated movement. For that reason, I have the patient in a harness which is connected via a rope block and tackle to an eyelet in the ceiling. 

Anyways, I thought I'd bring in another perspective to provoke thinking. I tend to disagree that including sessions on a treadmill do not lead to better outcomes. What matters is immediate feedback and increasing the challenge while keeping the patient safe.

Below you will find a quick view of the abstract.

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Aug 13, 2017 | Selena Horner

When is Chest Pain a Fractured Rib?

Since many physical therapists have some level of direct access (or what physiotherapists refer to as self-referral), I tend to keep my eyes open for research that helps me with differential diagnosis.

Chest pain... now that could have a scary complication, right? Is there a way to come to a conclusion that the person has a rib fracture? I find it interesting that history of recent trauma and age greater than 40 years were predictive factors. I wonder if pain with inhalation or coughing were considered?

Below you will find a quick view of the abstract.

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Aug 10, 2017 | Selena Horner

Retear of Rotator Cuff Repairs

Clinicians are not in full control of final results after a rotator cuff repair. We all know that there is always the complication of a failed repair. Failure can occur for a variety of reasons. The one that we need to definitely keep in the back of our mind, because it relates to using the shoulder: retear rates.

How hard do we push and progress a patient? Are some patients better candidates for a more aggressive program than others?

In my practice the majority of my patients are older adults. This study is nice in the sense that it reported the complication of retears across age groups. Based on the findings, I think it does a nice job in highlighting which patients are not candidates for an aggressive program.

Below you will find a quick view of the abstract.

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Aug 07, 2017 | Selena Horner

Stem Cells in the Management of Rheumatic Diseases

As technology changes and provides new treatment options, are we ready to evaluate the changes that may occur with the care we provide? Meaning... is there a difference in the rehabilitation outcomes of someone who has received stem cell treatments versus someone who hasn't? 

I know that typically this my questions would typically be answered via a randomized controlled trial. Yet... shouldn't we also know the answer with real life patients using practice based evidence?

FOTO has a way, built into its system, for you to create your own special groups of patients. You can definitely create a category of patients who have had stem cell treatment and a category for patients who have not. You can easily compare. The capability to do this could definitely set you apart with physicians in the community who are truly interested in being able to compare results. Granted, many colleagues will be thinking there is a bias... there isn't any randomization.... the clinician knows what treatments the patient has received in the past. Reality: real clinical life is messy and in the real world, clinicians have to treat patients on their schedules. Practice based evidence looks at retrospective data to help clinicians learn.

Below you will find a quick view of the abstract.

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