All outcomes measurement tools are not created equal! Valid, reliable, responsive and risk-adjusted outcomes data is important for accurately establishing your value as an efficient and effective clinician. The ability to show objective evidence of your quality to patients, physicians and payers depends on the outcomes tools you use and the strength of the system measuring your outcomes.
To maximize your ability to show your service was effective and efficient, you need robust outcomes tools. The tools need to measure a broad range of function and be responsive to patient change. Legacy outcomes measurement tools (Oswestry Disability Index, Neck Disability Index, Lower Extremity Functional Scale, etc.) are static, unchanging measures that have limitations assessing a wide breadth of high and low functional ability. If an outcomes tool is static, every single patient responds to the same items, statements or questions within the tool. With legacy functional measurement tools, you must administer all questions, score, and store the results manually or use a service that has automated the scoring process. Static measures may not capture the smaller incremental functional changes your patient may experience.
The first step as a requisite for improved payment is to have a measurement system that includes outcomes tools that are flexible and responsive to change. Focus on Therapeutic Outcomes (FOTO) and the Activity Measure for Post Acute Care (AM-PAC) are the only two options that fit this criteria. The outcomes measurement tools within FOTO and the AM-PAC are dynamic, responsive to patient-centered change, and assess a broad range of functional ability. FOTO is currently used mainly in the outpatient setting and AM-PAC in the post-acute setting.
Both FOTO and AM-PAC have the added advantage of using sophisticated computer adaptive testing (CAT) programming to make administration of the outcome tool very efficient. Because the CAT process significantly reduces the time to respond to items, it is more efficient, saving patient and therapist time.
Payers have changed their focus to value-based purchasing or pay for performance (P4P). Centers for Medicare and Medicaid Services project 50% of Medicare payments by 2018 will be P4P based. Payers in Louisiana, Minnesota, California, Arizona and other states have already implemented rehabilitation P4P programs. The key component in these programs is risk-adjustment which accurately allows valid comparisons of effectiveness and efficiency across all providers. The provider’s accumulated risk-adjusted outcomes are compared to benchmarked, risk-adjusted standards. Payment is based on overall efficiency and effectiveness. Providers who continue to compile their own in-house data using legacy outcome measures will not be able to take advantage of risk-adjustment.
The viability of rehabilitation providers in the future will be determined by measuring the quality of their care. Choose the outcomes system that enables you to be rewarded for your quality care because it is efficient, responsive, valid, reliable and risk-adjusted. The legacy tools were good when they were developed, but the art and science of measuring outcomes has advanced and you should too.
Until next time,