FOTO Rehab Outcomes

Sep 18, 2017 | Selena Horner

Can You Defend Your Value?

Quite a bit has been on my mind recently. My specialty is working with older adults.  My FOTO profile compares my patient demographics with FOTO's large database. My profile indicates my practice is quite different and is heavily weighted with a really high percentage of patients who are 65+.  This was great to see because I have worked at ensuring I target those who are 65+ in my community and with local physicians.  

As I was looking at my company's profile data, my gut dropped when I saw how many of the patients treated have a lot of co-morbidities. My initial gut response was a bit of worry. You see, I am categorized as an individual provider by a company called Evicore. Evicore has a contract with Blue Cross Blue Shield of Michigan to categorize the level of care I provide to patients.  Evicore is also contracted to be a gatekeeper and provides authorization for physical therapy services based on a provider's category. 

My initial gut response was because Evicore doesn't really base a provider's category on a strong risk adjustment process. If my patients take more time to achieve outcomes, how can I 1) show that my patients are different than the typical practice and 2) provide real outcomes of care for patients who have a specific payer?

Do you know how you can use FOTO to be your defender?

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Sep 15, 2017 | Selena Horner

Injury Rates in Cliff and Splash Diving

My curiosity drove me to post this study. I didn't know there was a such thing as splash diving. The only kind of "splash" diving I was aware of was back when I was a kid and we tried to have the biggest splash with a cannonball. I still remember goofing around trying to make a big splash by doing a belly smacker. That was a one time only intentional choice. To better understand this study, I found some videos. Think of it as a lesson in observing our body's amazing ability to move... and instead of watching someone's gait, you are watching movements in the air. Also, keep your eyes on how the body enters the water. 

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Sep 11, 2017 | Selena Horner

Guidelines for Gait Assessment

Before I purchased my four-legged wonder, I spent so much time watching videos and trying to understand equine gait.  I spent time trying to figure out which leg was doing what and what was different between a gaited horse and a quarter horse. And then, after I got my four-legged wonder, I spend months figuring out how to get him into that smooth gait. Lucky for us, our patients have two legs instead of four.

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Sep 08, 2017 | Selena Horner

Is there a Return on Investment for Measuring Quality?

Payment for services doesn't seem to increase as much as we'd like. Our costs to provide services increase annually, yet payment for services doesn't increase at the same rate.

It seems we have an increase in time and burden meeting various regulations. Twenty-five years ago managing patients was much more simple than it is now.  If I rely on my memory, I can recall a group of patients having overlapping appointments. I could double or triple book and spent time knowing what patients needed and putting thought into who overlapped with who so that the right kind of synergy could happen between patients and their interactions. I remember the clinic feeling more crazy and full of energy. I don't recall having to focus on the clock. I didn't have to worry about one-on-one codes. I believe I did write progress notes every 30 days. I don't recall physicians needing to sign progress notes and keeping track of receiving signatures.

In my current practice, there is no way I can use a plain old paper schedule book and pencil with an eraser as one of the most important tools in my clinical day. I rely on my electronic medical record to handle not only scheduling, but also timing my codes and helping with billing. I rely on that system to know or remind me of what I need to do to meet all the crazy rules and regulations so that my documentation meets requirements. 

Now we have the added burden of reporting functional limitation. Is there a return on investment for outcomes measurement systems?

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Sep 06, 2017 | Selena Horner

Medicare and Maintenance Therapy

 Four years ago Glenda Jimmo filed a case against Health and Human Services in the US District Court in Vermont. The final outcome is what many of us are familiar is the Jimmo Agreement. Centers for Medicare and Medicaid Services (CMS) have been going through the completion of the various aspects of the agreement. As of August 2017, CMS created a special web page informing all about this agreement.

For many of us in the rehabilitation world, we have it engrained in our brains that in order for services to be covered by the federal payer OR an advantage plan, the patient has to demonstrate improvement. We need to wrap our heads around the fact that we've been led to believe something that isn't true. Reality is that the federal plan covers maintenance therapy. If a patient's status can be maintained with services OR if decline can be prevented with services, then it is perfectly acceptable to provide services that will be paid by the federal insurance plan.

What do we need to have in place in the event our services are under scrutiny?

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Sep 03, 2017 | Selena Horner

What's Real?

 A few weeks ago I spent some time in Chicago for a couple of days. I have this uncanny ability to get lost in many of my traveling adventures. Whether I have a compass, the navigator app on my phone or even someone verbally telling me 12 step directions, I tend to easily become lost. I have zero sense of direction whether in a city or on a trail in the woods.  

As I was trying to figure out how to get to the Navy Pier, I took a little excursion to see a whole lot of sailboats. The colors and the lines snagged my attention to such a degree I had to snap a photo. The whites and the blues... the perpendicular lines... with a backdrop of really tall buildings just seemed to appear really neat.

When I see the above image, an important question pops into my head.

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Aug 31, 2017 | Selena Horner

When is Central Sensitization a Factor in Knee Osteoarthritis?

I remember reading an interesting tale quite a few years ago. The story was about a grandma who attended a field trip to a local university research laboratory with her grandson. Picture a large machine that when placing your hands into it would project an image of the hands like what happens at fairs and amusement parks with the image distorting mirrors. The grandma wanted to participate in the experiments with her grandson.

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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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