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New FOTO Research Abstract:  Impact of Risk Adjustment on Provider Rankings for Value Based Payment Programs 

Focus on Therapeutic Outcomes, Inc. (FOTO) today announced that a new research study led by Dr. Daniel Deutscher, PT, PhD has been accepted for publication by the Journal of Orthopaedic and Sports Physical Therapy (www.jospt.org). Dr. Deutscher’s research utilizes FOTO’s comprehensive database of rehabilitation outcomes housing 21 million patient assessments.



Deutscher D, Werneke MW, Hayes DH, Mioduski JE, Cook KF, Fritz J, Woodhouse LJ, Stratford PW.  Impact of Risk-Adjustment on Provider Ranking for Patients with Low Back Pain Receiving Physical Therapy. J Orthop Sports Phys Ther (in press).

 Study Design: Retrospective Cohort

 Background: Impact of risk-adjustment on clinic quality ranking for patients treated in physical therapy outpatient clinics is unknown.

Objectives: To compare clinic ranking, based on unadjusted vs. risk-adjusted outcomes, for patients with low back pain (LBP) treated in physical therapy.

Methods: Secondary analysis of data from adult patients with LBP treated in outpatient physical therapy clinics during 2014-2016. Patients with complete outcomes data at admission and discharge were included to develop the risk-adjustment model. Only clinics with complete outcomes data for at least 50% of patients, and 10 or more complete episodes of care per clinician per year, were included for ranking assessment. R-squared shrinkage and predictive ratio were used to assess for overfitting. Percentile ranking by deciles, or three distinct quality ranks based on uncertainty assessment, were used to assess agreement between unadjusted and adjusted rankings.

 Results: The primary sample included 414,125 patients (mean age (SD) =57(17); 60% women) treated by 12,569 clinicians from 3,048 clinics from all US states; 82% of patients from 2,107 clinics were included in the ranking assessment. R-squared shrinkage was less than 1% with a predictive ratio of 1. Risk-adjustment impacted ranking for 70% or 31% of clinics based on deciles or three distinct quality levels, respectively.

 Conclusion: Important changes in ranking were found after adjusting for basic patient characteristics of those admitted to physical therapy for treatment of LBP. Risk-adjustment profiling is necessary to more accurately reflect quality of care when treating patients with LBP.

 Level of Evidence: Therapy, level 2b.

Key words: risk-adjustment, provider ranking, physical therapy, patient reported outcomes measures, functional status

Correspondence to Dr. Deutscher deutsch_d@mac.org.il

Link to press release:  https://www.businesswire.com/news/home/20180221005926/en 

About FOTO

FOTO is a Knoxville, TN based corporation that has been continuously improving solutions to efficiently measure and reliably report functional outcomes for the rehabilitation industry for over 26 years. FOTO’s web-based solutions are risk-adjusted to enable fair and accurate measurement and predictions of the expected improvement in patients’ functional status. Approximately 21 million patient assessments have been compiled in the FOTO database, and researchers have utilized FOTO data to publish over 100 articles on functional outcomes in refereed medical journals. These publications have led the way in enhancing the science of measuring outcomes and the use of outcomes in payment methodologies. FOTO is the standard in measuring functional outcomes in rehabilitation.

Learn more at FOTO or contact Judy Holder at 1-800-482-3686 x 238.

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