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FOTO Rehab Outcomes Blog

Part 2 - Outcomes Conference Wrap Up: Who Said This?

Conferences focused around a single topic will have attendees that share the same passion. FOTO's outcomes conference is second-to-none. Every year clinical, research and business leaders come together to share and learn the value of outcomes in the rehabilitation industry.

Today's post is a second in a series of many. Last week I kicked off the first in a series about the outcomes conference. 

Who Said This?


If you guessed Pedro Gozalo at Center for Gerontology and Health Care Research at Brown University, you are correct! 

You know how you report the functional limitation G-codes and severity modifiers for every patient who has Medicare? Well... WAY back before the severity modifiers were implemented, I know many rehabilitation professionals who had issues with the percent impairment model. Pedro shared a scientific reason for eliminating the current severity modifier structure. Pedro shared his findings comparing FOTO scores against the severity modifiers.

Here's my deep thinking on this topic. The reason the severity modifier model doesn't work is because this model 1) does not take into consideration the patient reported outcome measure used, 2) does not consider the minimal clinically important difference of the patient reported outcome measure and 3) does not standardize the way to define each percent impairment.

The questions I've always had around this impairment model: How exactly is a 19% impairment easily identifiable from a 20% impairment? If a patient begins services at 19% impairment and ends at 20% impairment, why does that get rewarded compared to a patient who begins services with a 21% impairment and ends with a 39% impairment? Aren't we really interested in the change that happens versus some definition of the level of impairment?

Since Pedro is currently the lead investigator on a Centers for Medicare and Medicaid Services (CMS) contract to update the hospice payment model, I'm hoping he can help realize that their current severity modifier model for the outpatient world isn't very helpful in capturing what happens in the outpatient rehabilitation world.

Who Said This?


If you guessed Julie Fritz at University of Utah, you are correct! 

Julie presented on care pathways for back pain. Pathways are guidelines put into real life. You can map out from when a patient with back pain enters the system, who the patient sees, and what the the patient receives. You can even see the timing of when everything happens.

The below slide interested me. What is the difference in the cost of care based on which provider the patient saw first? Okay... I knew there would be a difference. It was interesting to see the costs.


If a person has back pain, a physical therapist or a chiropractor is the best option from a cost perspective. That does intuitively make sense because both physical therapists and chiropractors provide conservative care options.

Interestingly though, a chiropractor may consume more than a 1/3 of the year of one's life addressing back pain.


Good stuff, right? The data is very positive from both a cost and efficiency perspective on which provider is the best provider for treating individuals who have low back pain. The question not answered: how much did the patient change? Which provider is more effective?

In the event you are curious about presentations from previous years, you can find them here. I have LOTS more to share from the most recent conference! Stay tuned!

Until next time,