Carl Sandberg’s 1914 poem “Chicago” spawned one of the city’s most popular nicknames: the City of Big Shoulders. The moniker proudly implies that Chicagoans are work horses—always carrying the weight of the world on their shoulders. They’re the toilers, the builders, and the difference-makers. By that definition, rehab therapy is certainly the Profession of Big Shoulders.
Thus, it makes sense that this year’s Ascend 2015 took place in the heart of Chicagoland. And as the two-day event unfolded, that reasoning only became more apparent, because this group of 250 attendees (comprised of rehab professionals, thought leaders, and trailblazers) truly love their work—and boy, do they work. The result? Major positive differences in the lives of all their patients and incredible healthcare achievements made without costly drugs, surgeries, and diagnostics.
At the same time, they, like the Chicagoans, have quite a lot to shoulder—from declining reimbursements and intensifying regulations to evolving payment models and increasing competition. (Thankfully, they have those big shoulders.) Unfortunately, though, like most work horses, rehab therapy professionals are humble, and they assume that doing the work is enough. But in today’s healthcare industry, fortune favors the bold. Scratch that; it favors the data. And that leads me to the major overarching theme of Ascend 2015: Data is the future of rehab. Without it, rehab might not have a future—at least, not a bright one. On that note, here are a few key takeaways from this year’s conference, in the words of some of Ascend’s most renowned speakers.
“We cannot wait around for a perfect system.” – Dr. Julie Fritz
Today, most healthcare professionals rely on a fee-for-service system to get paid. That system has changed over time, but not in a beneficial way. As Dr. Jeff Hathaway explained in his presentation, “We’ve switched from making it cheaper to making it cheaper and predictable.” The healthcare system is about to make a huge shift, though. To achieve its so-called “triple aim,” the federal government is moving health care toward value-based payment models. This is what Dr. Julie Fritz discussed in her presentation on Thursday. And while an introduction to pay-for-performance models would have sufficed, Dr. Fritz took it a step further by detailing how rehab therapists are to succeed in the changing payment landscape: they need to collect outcomes, and they need to do it now. "Transparent, reliable measures of patient-centered outcomes are necessary to drive improvement and learning,” she explained. More importantly, they’re necessary if therapists want to demonstrate value and patient improvement, and thus, receive payment for services rendered.
Now, some practitioners are wary of changing their practices. Instead, they’re hunkering down and sticking to the “way things have always been” until the APTA perfects its payment proposal, the government actually rolls out anything it’s proposed, or insurers initiate new reimbursement regulations. But to circle back to Dr. Fritz’s argument, holding out will only haunt you in the end, because while you wait for a “perfect system,” those around you are jumping aboard the outcomes train. They’re amassing tons of data, which they’ll be able to use to demonstrate value to payers and patients. The longer you wait, the harder you’ll have to work to catch up.
“More is not better. Less is not better. Better is better.” – Dr. Troy Bage
When you start talking about collecting outcomes, the conversation naturally turns to benchmarking. After all, one of the main reasons for collecting outcomes is to enable providers and payers alike to conduct comparative research, whether that’s internally (for performance analysis) or externally (for local, regional, and national ratings). This is what Dr. Troy Bage discussed in his presentation: using outcomes data as a benchmarking mechanism to raise the bar for our profession as a whole, better negotiate with insurance companies, and better market our practices.
Of course, benchmarking can cause some uneasiness. As Dr. Julie Fritz explained in her presentation, the culture of individuals, of practices, and of an entire profession must be ready for value-based payment, because accountability is key to improving outcomes. What does that mean? Dr. Bage explained it simply: sometimes, providers aren’t doing as good of a job as they think they are. However, "...the point of value-based payment is not to weed out the bad,” explained Dr. Fritz, “but to make every provider better." Both Dr. Bage and Dr. Jeff Hathaway concurred with Dr. Fritz in their presentations: they both used the phrase “better is better.” The purpose of benchmarking is to establish a baseline upon which to improve. After all, there is always room for every clinician to improve, and in the end, your patients benefit the most from that improvement. After all, as Dr. Bage said, "When we satisfy patients, all we're doing is meeting their minimum expectations. We must do more." Outcomes is the doing; improving upon the data we collect is the more.
“You don’t manage value; you leverage it.”– Dr. Jeff Hathaway
Dr. Fritz emphasized the importance of collecting outcomes; Dr. Bage detailed how to use the outcomes you collect to benchmark, improve, and use those ratings to your benefit; and Dr. Hathaway brought it home by explaining how to think about all of this like a payer. “Adding services doesn’t get you more or better payments.” Understanding your value in cold, hard data—and then using that data to negotiate with insurances companies—does. Unfortunately, without data, PT remains a commodity—something without real value. “And if we play like a commodity, we’ll be treated like a commodity,” Dr. Hathaway stated.
As every single person at Ascend—and throughout the healthcare community—knows all too well, payers care about cost. Every payer has a cost-for-care pie that includes slices for all types of providers and services. “You’re not going to get paid more to make that pie bigger,” explained Dr. Hathaway. That means insurance companies never want the cost of caring for a patient to go up, and they’re never going to reward a provider for increasing the cost of care. Thus, you as a therapist “have to figure out how to steal some slices or shrink the pie.” How? Data. “We can de-commoditize PT by using data to demonstrate value,” Dr. Hathaway continued. That’s leverage.
Of course, the first step is actually collecting the data. As Dr. Heidi Jannenga asked on day two of Ascend, who all is going to start collecting outcomes in their practice following this conference? Everyone in attendance raised their hands. Okay, step one complete: People know they have to do it, so now, do it—and do it universally—because as Dr. Bage said, “Collecting outcomes on 40-50% of our patients is not collecting outcomes.” There must be a clinic-wide commitment to outcomes collection, tracking, and measurement on the majority—or even better, all—of your patients.
Weighty stuff, right? Good thing rehab therapists have such big shoulders. And this recap doesn’t cover even half of the presentations that unfolded at Ascend. There was so much more data talk to be had. Stay tuned for tomorrow’s post, when I tackle data from a non-outcomes angle. Yes, you heard right. When it comes to running a private practice (i.e., a business), there’s more to track than outcome measures.