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FOTO Rehab Outcomes Blog

Sep 24, 2017 | Selena Horner

What Makes a Good Clinical Prediction?

When it comes to predicting outcomes, one of the most important questions you can ask is, "how much variance is explained?" The savvy person focuses on this question because the accuracy of the prediction depends on the response to this question.  If a prediction is used for future decisions, like quality payment programs, then you want the most accurate prediction possible.

To have 100% variance explained is quite improbable.  Teams creating prediction models are focused on as high amount of variance explained as possible.

How much information should patients be providing to help explain variance?

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Sep 21, 2017 | Selena Horner

Total Knee Arthroplasty and Blood Flow Restriction Training

I know a physical therapist who is highly involved in blood flow restriction training research.  The results of blood flow restriction training are quite impressive for the individuals in which it was intended: for those who have severe exercise restrictions due to procedures the soldiers have underwent.

This study has me pause and wonder. Do you have similar thoughts?

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Sep 20, 2017 | Selena Horner

Patients' Perceptions and Expectations

Although many hang their hats on quantitative studies and randomized controlled trials, I appreciate qualitative studies. I find the thoughts and perspectives that people have to be quite interesting. Qualititative studies that shed light on what people think are golden insights that can be used to improve delivery of services and outcomes.

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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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