Today I happened upon a jackpot of a conversation revolving around outcomes. The beauty of twitter is the conversations that happen - genuine and authentic. I'd like to share my thoughts about the conversation.
The whole conversation initially started after @ptbise shared a recent article published by John Childs et al. Which setting provides better outcomes - hospital or private practice? Although an excellent point was made about cost of care, this study cannot address that question. The only current studies in peer reviewed literature that combine FOTO data and can accurately address cost of care would be those published by Daniel Deutscher in Israel.
With regard to @SarahHaagPT comment that FOTO is not a standard in smaller practices, based on the data in this study, many private practices were included in the study.
As you can see, quite a few private practices were included in the study. Based on the patient n numbers, I would be willing to guess that the private practices may not be using FOTO for every single patient receiving services OR there is a substantial difference in provision of services. In my mind, there should be substantially more patients in the private practice group. This data does not provide an explanation.
When discussing outcomes, it is often assumed "sicker" patients are found in particular settings. Some clinicians believe they have "sicker" patients. Or... if not "sicker" then more complicated as @SarahHaagPT points out. FOTO is able to provide data on the number of co-morbidities for groups of patients. Co-morbidities are considered one category for risk adjusting outcomes in the FOTO system.
Do the patients appear more "sicker" in one setting versus the other?
In my opinion, both groups appear quite similar. Although a very slight difference is noted in other health problems, I'm not convinced it is clinically relevant. (Edit: I do see a difference in payer mix. PPO may be more lenient with number of visits; HMO typically limit visits. Not sure if it's enough to explain visit differences between hospitals and private practices.)
And, @Jerry_DurhamPT, the FOTO system does define quality. Quality is not a magical unicorn. Your comment offends me. So much work is being done with regard to outcomes and comparative effectiveness studies. We have high caliber colleagues analyzing data, please don't tell them their work hinges on a magical unicorn. At the top of my head: Julie Fritz, Stephen Hunter, Gerard Brennan, John Childs, Daniel Pinto and Tony Delitto all fall into the category of health science research.
Yes, @WebPT and @HeidiJannenga work is definitely being done in the Pay for Performance world. FOTO led this whole concept when Dennis Hart and Jerome Connolly presented their final report on this topic to Centers for Medicare and Medicaid Services back in 2006. Therapy Partners (Jim Hoyme, Jeff Hathaway and Craig Johnson) is leading the way in contract negotiations for payments that include a quality component. Remember, the tool used for tracking outcomes for a pay for performance model needs to be of a high enough caliber to risk adjust. All of our old, familiar tools are fantastic for assessing the individual patient in front of us. Those old, familiar tools are not robust enough to risk adjust for group comparisons. They were not futuristically designed for this current need.
Thanks to each of you for a quality discussion revolving around outcomes. I wish my day had been a bit more empty yesterday and I would have loved to have jumped in live with my thoughts!
Until next time,