New report designed to help improve patients’ quality of care and establish baseline metrics for determining the value of physical therapy.
A group of physical therapy stakeholders – making up the Physical Therapy Industry (PTI) Outcome Workgroup – released a new report that establishes benchmarks of quality care in the field of physical therapy. As the first report of its kind, the results provide physical therapists (PTs) with key insights into the delivery of high-value care while also helping policymakers and payers better determine the value of PT services provided to millions of Americans every year.
To minimize variation and improve the quality of care provided to consumers, health plans, and employers, the work group evaluated how clinical outcomes could be used by the physical therapy community to enhance the value of care. Specifically, how benchmarking can improve value-based payment and outcomes reporting for providers and the broader health care industry.
“By engaging in this collaborative effort with physical therapy stakeholders representing all 50 states, our community has reached a major milestone in advancing high-quality care and value for our patients,” said Bridget Morehouse, senior vice president of contracts and pricing at ATI Physical Therapy and spokeswoman for the work group. “To advance these goals, the PT community is proud to develop the new quality care benchmarks that will help underscore the tremendous value of physical therapy in helping Americans recover from injuries and illness, manage their pain, and regain their independence.”
The report produced the largest multi-practice analysis of open source, risk-adjusted clinical outcomes in the outpatient physical therapy industry. After carefully analyzing data that covers 375,000 patient episodes in all 50 states, the work group established national clinical outcomes benchmarks across the three most common areas in outpatient orthopedics (spine, shoulder, and knee care, which represent approximately 80% of orthopedic care), while using a risk-adjustment and stratification approach approved by the Centers for Medicare & Medicaid Services (CMS) and adopted from the orthopedic community.
Other key findings include:
• Clinically important improvements in patient-reported outcomes (PRO) were observed across body regions over 12-14 visits.
• Baseline patient factors for all data contributors explain a large portion of variation in PRO change within episodes. Payer type, patient socio-demographic factors, and co-morbidities at baseline all had strong effects on PRO changes over episodes of care. Differences in these baseline patient factors must be accounted for to ensure fair performance comparisons of physical therapists.
When reporting clinical outcomes as a measure of quality of care for outpatient physical therapy, risk adjustment should be considered and include factors such as BMI, patient age, co-morbidities, smoking status, chronicity, pain, zip code of residency, and payer type; these factors influence the patient outcome and the utilization of physical therapist services.
“This report further supports the importance of PRO in clinical practice to evaluate the outcomes of our patients, and highlights the need for standardized data collection by physical therapists to include key patient characteristics that can be used to risk adjust these measures,” said Heather Smith, PT, MPH, APTA public affairs director of quality.
“The benchmarks established in this report show that physical therapy adds incredible value to both patient care and the broader health care system,” said Nikesh Patel, PT, executive director of APTQI. “Based on the outcomes of this analysis, we urge payers to reflect the value of physical therapy in future insurance design and reduce barriers to PT treatment.”
The volunteer work group of industry stakeholders was formed in August 2015 to create a collective voice for the physical therapy profession to evaluate how clinical outcomes could be used to improve quality of care, minimize variation, and establish value-based payment and outcomes reporting for consumers, health plans, employers, and the health care industry. The work group consisted of industry stakeholders from the American Physical Therapy Association, Alliance for Physical Therapy Quality and Innovation, WebPT, Select Medical, BMS Practice Solutions, Intermountain Health Care, PT Northwest, ATI Physical Therapy, and US Physical Therapy. The group evaluated the ability of PRO as performance measures and created national benchmarks, where possible, for use in outpatient physical therapist practice.
The group contracted with the Center for Effectiveness Research in Orthopedics to develop risk adjusted performance measure algorithms for physical therapists using legacy patient-reported outcome measures and patient-level information. Read the full report (.pdf), titled “Evaluation of Legacy Patient-Reported Outcome Measures as Performance Measures in Rehabilitation.”