Chuck Klosterman, author of Sex, Drugs, and Cocoa Puffs, will tell you that you absolutely can compare apples to oranges. However, he’s never worked in health care. Sure, both apples and oranges are fruits—just like all patients are people. But picture this: two PT clinics—both alike in dignity, in fair USA, where we lay our scene. One clinic averages 10 visits per case; the other, 20. If that’s all you have to go by, then you probably assume the first clinic is much more efficient—and effective—at patient care.

Not so fast. After all, case and patient mix are critical factors. Perhaps the second clinic treats patients with more severe injuries or complicated pre-existing conditions. Thus, comparing clinics based solely on case-load efficacy is unfair. To truly measure the quality of care provided, one must examine the patient outcomes achieved.

But again, we run into an apples-to-oranges problem. Considering scores of regularly completed outcome measurement tools (OMTs) alone, one clinic may demonstrate faster functional improvement compared to other clinics. However, certain patients heal better than others. Let’s use two ACL reconstruction rehab patients as an example: one takes 10 visits longer to achieve the same level of function as the other. But that's not necessarily a reflection of the quality of the care each patient received, because one patient is 30 years older than the other and also suffers from knee osteoarthritis. Both patients receive excellent care, and both patients get better. But without taking into account these critical patient case details, all you have on paper is a visit count—and that’s not the sole way practitioners want to be judged.

Thus, if clinicians don’t take complicating factors into account, then the quality of their data, the justification of their care, and ultimately, the legitimacy of PT in general are all invalid. And that hurts bottom lines, as this study from the Journal of the American Physical Therapy Association explains: “assessments of provider performance that are tied to public reporting or financial incentives that are based on unadjusted outcomes may penalize providers treating the sickest patients who fail to show enough improvement or require more visits in a treatment episode.”

So, how do practitioners account for complicating factors consistently and at scale? Enter risk adjustment. According to this overview published on CMS’s website, “The purpose of risk adjustment when comparing outcome rates (e.g., hospitalization rates) for two different patient samples is to statistically compensate (or adjust) for risk factor differences in the two samples so that the outcome rates can be compared legitimately despite the differences in risk factors.”

Whereas unadjusted outcomes can lead to poor payment or penalties, risk-adjusted outcomes—and the valid data they provide—help level the data playing field. According to this risk adjustment primer by the Veterans Health Administration (VHA), “risk adjustment facilitates more rational resource allocation based on need. Most capitated payment methods use some type of risk adjustment to come up with payment amounts that take into account providers’ resource requirements for treating their patients.”

Furthermore, risk-adjusted OMTs allow healthcare practitioners and payers to establish baselines for tracking quality and efficacy over time, both internally and across facilities, regions, and the country. Similarly, such measures allow practitioners to prove the effectiveness of specific treatments or interventions. “Without adequate risk adjustment, it is impossible to say whether perceived improvements in patient outcomes reflect better treatment, healthier patients or other factors,” states the VHA primer.

To circle back to our two ACL patients, let’s assume the therapists regularly use the lower extremity functional scale (LEFS) to assess improvement throughout both episodes of care. LEFS accounts for age and other complicating factors. Thus, the therapists are able to better—and more fairly—assess and prove the efficacy of their care.

For all of the above reasons, OMTs must be risk-adjusted, which means test results take into account differing levels of patient complexity, such as age, weight, litigation, diabetes, cancer, and heart disease. (For a list of some of the most popular risk-adjusted OMTs, check out this post.) Patient complexity doesn’t end with the aforementioned comorbidities, though. According to the VHA primer:

Geographic factors, population densities and distances between facilities may have profound effects on practice patterns, access to care and patient outcomes. Coverage limits that differ across state medical aid programs may influence veterans’ illness severity, as well as the spectrum of services those veterans seek from VHA. In addition, recent research has shown that higher patient income is positively associated with better clinical outcomes.

And as the previously cited CMS overview states, “In general, risk factors for an outcome are chosen first by conceptually and clinically specifying the potential risk factors, and then assessing which ones are empirically related to the outcome.” (For a deeper dive into the methodologies and processes for developing those models, I recommend this CMS overview. While it focuses specifically on home health, its discussion of risk adjustment is very informative.)


Payment reform is happening, and the key to ensuring not only proper payment, but also physical therapy’s rightful place in the care continuum, is outcomes data. But it has to be the right outcomes data. And as Heidi stated in her recent founder letter, that’s data that is “measureable, comparable, actionable, and perhaps most importantly, meaningful to all stakeholders.” Risk-adjustment ensures the comparability of data, which moves PTs one step closer to proving their worth and effecting change with payers. To frame it Matt Damon-style, it empowers you to ask, “How you like dem apples?

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  • Why You Shouldn't Track Outcomes in Isolation Image

    articleFeb 29, 2016 | 3 min. read

    Why You Shouldn't Track Outcomes in Isolation

    Outcomes has been a popular topic of conversation lately; as health care drifts further away from a volume-based payment environment, proving the value of your treatment will become essential to getting paid. According to this article on PhysicalTherapist.com, as provider incentives begin to change, your “strategy and behavior must change as well.” Tracking outcomes is a giant leap for rehab therapists—but if you’re tracking outcomes at your clinic only, then Houston, we have a problem. To make …

  • Founder Letter: We Are Not a Commodity: The Value of Physical Therapists vs. Physical Therapy Image

    articleAug 9, 2016 | 6 min. read

    Founder Letter: We Are Not a Commodity: The Value of Physical Therapists vs. Physical Therapy

    “I’m going to physical therapy.” Whenever anyone—a friend, a colleague, or even a family member—says this to me, I feel a twinge of disappointment. I know, it sounds crazy coming from me; I am a physical therapist, after all. But that is precisely the reason behind my discontent: I am a physical therapist—a doctorate-level medical professional with the skills and education necessary to diagnose, treat, and coordinate care for my patients. I am not some nameless, faceless …

  • Founder Letter: Why I’m Betting on Outcomes Image

    articleFeb 4, 2016 | 5 min. read

    Founder Letter: Why I’m Betting on Outcomes

    I’m not much of a gambler. Some folks enjoy the rush that comes with putting all their chips on the table and risking everything on a single roll of the dice. Well, no offense to all you card sharks out there, but if I’m going to go all in, it better be on something I’m pretty darn sure of. So, when I say I’m betting on outcomes, you know I’m not bluffing. In fact, I’m 100% confident …

  • WebPT Outcomes OMT Reference Guide Image

    downloadDec 22, 2016

    WebPT Outcomes OMT Reference Guide

    Ever feel like the results your patients achieve don’t match up to the statistics your payers bring to the negotiation table? Now you can prove them wrong. Collecting objective patient data can help you, the rehab therapist, yield better patient outcomes—and pad your bottom line in the process. And that’s kind of a big deal in today’s value-based healthcare system. Today, with the right practice management tools—including WebPT Outcomes—it’s easier than ever to set concrete performance goals …

  • Triumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success Image

    downloadSep 28, 2016

    Triumph in the Triple-Aim Game: The Healthcare Executive’s Guide to Readmission Reduction, Patient Safety Promotion, and ACO Success

    The Affordable Care Act (ACA) and other reform efforts have brought forth a renewed emphasis on care coordination at all points along the care continuum—including the period after hospital discharge. As part of this push, new financial incentives and penalties have put healthcare executives at the center of a high-pressure game of tug-of-war in which they must simultaneously improve care quality and reduce costs. Talk about a catch-22. Enter your email address below to download this guide …

  • WebPT Member Q&A: Why PTs Absolutely Must Track Outcomes Image

    articleFeb 27, 2017 | 7 min. read

    WebPT Member Q&A: Why PTs Absolutely Must Track Outcomes

    Brian Rodriguez, PT, DPT, OCS, is the owner of Utah Physical Therapy Specialists in West Jordan, Utah. There, he treats a variety of orthopedic conditions, specializing in sports injuries, spine problems, headaches, auto accident cases, geriatric problems, and work injuries. A WebPT Member since 2012, Brian’s clinic was one of the first to put WebPT Outcomes to work. In this interview-style post, Brian provides his two-cents on the importance of outcomes tracking , explains how he built …

  • Breaking Bad Habits: The Modern PT’s Formula for Success Image

    webinarJun 7, 2016

    Breaking Bad Habits: The Modern PT’s Formula for Success

    Since the dawn of rehab therapy, PTs have been operating in a system of restriction. In some cases, that’s a good thing—after all, therapists pride themselves in treating and healing their patients within the confines of evidence-based practice. But in many ways, the traditional system is broken—and that’s only growing more apparent as we enter a new age of health care: the era of value-based care delivery. For too long, rehab therapists have left it up to …

  • Which Outcome Measurement Tool Should I Use and When? Image

    articleFeb 18, 2016 | 3 min. read

    Which Outcome Measurement Tool Should I Use and When?

    Earlier this month, we announced the launch of WebPT Outcomes , the first fully-integrated outcomes tracking software specifically for PTs and OTs. One big way that WebPT Outcomes differs from other rehab therapy outcomes tracking software is the outcome measurement tools (OMTs) our product contains. As WebPT president Heidi Jannenga explained in this month’s founder letter , “historically, therapists haven’t had access to outcomes tracking tools that (1) align with the type of care they provide, including …

  • Outcomes: A Clinician’s Simple Perspective Image

    articleMar 30, 2016 | 6 min. read

    Outcomes: A Clinician’s Simple Perspective

    International performance improvement expert H. James Harrington said, “Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”  Using outcomes instruments is an effective and relatively easy method for measuring and understanding a patient’s response to treatment. With a clearer understanding of patient responses to therapy interventions, …

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