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?
Return on investment can be viewed from a few different perspectives.
One perspective is reducing time burden. There is a time burden associated with reporting functional limitation. Lucky for me, TheraOffice does a fantastic job linking and importing FOTO scores. All I have to do is click a button and the codes magically populate onto my claims. Prior to this slick of an integration process, I'd have to go to review the FOTO report and look at the functional limitation codes and figure out which one I needed to use and then plug it into TheraOffice. Now, with the two systems talking to each other, I honestly no longer even think about which code or why. I have enough other more important clinical decisions to make in my day that I'm completely happy with an easy button.
Now, there is another time burden associated with using patient reported outcome measurement tools. Prior to FOTO, I had to determine which tool. I had to have paper copies. I had to hand the tool to the patient to complete. I'd have to wait for the patient to complete it. The paper copy needed to be scored. The copy then had to be scanned into the patient record. I then had to remember to put the scores in clinical documentation Then, because I wanted to look at my own aggregated data, that meant I first had to create a database. I had to create my own datasheets to manually complete from each patient record. I then had to manually input the data into the database. I then had to create queries. The data from the queries had to be dumped into Excel. I then had to run formulas to analyze the data. After that, I had to create a report to understand my aggregated data. The whole process was a great learning experience, yet at the same time a huge time drain. On top of that, there was no way to compare my results with any other clinician or clinic. If you are interested in the details, I shared my experience over at Physiopedia. Without FOTO, lots of unbillable time was spent focusing on quality management. What's different now is that at least 80% or more of my patients are emailed a link for initial (intake) assessment and status assessments. It takes about 30 seconds to set up a patient in FOTO (again, really fast with integration) and then 1 second to click a button to send an email to the patient. After a patient completes and episode of care, I just have to go into FOTO and close the case which takes me about 45 seconds. Any time I want to see my outcomes, all I have to do is log into my report portal and do a quality assurance check. I went from hours upon hours of data entry to one minute and 16 seconds per patient to have data. Better yet, FOTO's data is risk adjusted, provides an immediate prediction at intake which then allows for comparisons of care. This time saving allows me to be more productive and perform billable activities versus administrative activities. It also allows me to keep my administrative duties in the clinic versus eating into my leisure time, my training time or my home time.
We all know that from both a business perspective and from an outcomes perspective, we really do need our patients to attend their scheduled appointments. Lost visits reduce revenue and can affect the patient's final outcome. There are more and more products helping to improve attendance. Electronic medical records can help with phone or text reminders. Another area to consider is patient engagement. I would like to think that most would agree that an engaged patient will want to attend their scheduled appointments. My conversations are at times more like a flipped classroom because FOTO's reports have changed my interactions. Patients are seeing their results after completing their assessments. Patients want to beat the scores. Patients have an increase in their level of hope because they can immediately see if they should improve with a course of physical therapy services. FOTO created changes that elevate patient engagement with the goal to help patients attend their appointments for better outcomes and to also help reduce cancel and no show rates.
Patients are paying more out of pocket for their care. They want to save while at the same time receive quality care. They search online and ask about cost and also look for information about quality. It takes time and creativity to design content and material that promotes the quality of your services. From a trust perspective, it's better if quality rankings are based on third party measurement and analysis. If you could reduce your marketing costs and readily promote the quality of your services, you have a return on your investment if the effort gains new patients.
When thinking about your return on investment with an outcomes measurement system, what current business metrics need to be surpassed? We've thought about this at FOTO and have a return on investment calculator that helps you know how much three of your business metrics need to change after implementing FOTO. Try the return on investment calculator to see how you can make measuring and managing your outcomes an investment.
Until next time,