Physical Therapists’ Guide to Outcomes Tracking

Introduction

If you’re about to implement outcomes tracking in your clinic, congratulations! You—and your patients—soon will reap all of the benefits that outcomes tracking has to offer. After all, outcomes tracking allows physical and occupational therapists to enhance patient care and objectively demonstrate their clinical performance to insurance carriers, patients, and referral sources through quick patient data collection and industry standard, comprehensive reports. If your outcomes tracking solution also provides a diverse library of evidence-based, industry-accepted tests that are already familiar to—and respected within—the healthcare community at large, along with risk-adjusted national outcome comparison reports, then you’re already on the fast-track to outcomes tracking success.

But, before you dive into using this incredibly powerful tool, we recommend spending some time preparing. This will ensure you have a rock-solid plan for implementing—and maintaining—your outcomes tracking efforts. This way, you’ll be able to turn your data into meaningful insights that’ll help you achieve optimal patient outcomes and professional results.

Read on to learn everything you need to know about outcomes tracking—well, most of it anyway.

What is outcomes tracking?

Put simply, outcomes tracking is the collection and analysis of the results your patients achieve due to your therapeutic interventions. It’s data—cold, hard, irrefutable facts about your patients’ functional improvements. It’s the means necessary to maximize your value as a provider and objectively demonstrate that value to patients, payers, and the rest of the healthcare industry—so you’re not relying solely on anecdotes and stories. In today’s pay-for-performance healthcare landscape, data reigns supreme.

Why is outcomes tracking so important?

Change can be hard—especially when that change requires already-busy therapists to expend even a little bit of extra time and effort. But in the case of outcomes tracking, it’s worth it—for everyone involved. At this point, therapists can no longer afford not to collect and track outcomes data. It’s that important. Here’s why:

It Improves Patient Outcomes Through Evidence-Based Care

Unless you’re tracking results—via outcome measurement tools and patient satisfaction surveys—in a consistent and standardized manner, there’s no real way of knowing whether the prescribed plan of care is the most effective one available. With outcomes tracking, you’ll know which plans of care produce the best results for each diagnosis—and that means you and your colleagues will be able to make more educated decisions about clinic processes, best practices, and future treatment plans.

Plus, with the right outcomes tracking software solution, you’ll be able to control for complicating factors—such as age, weight, litigation, diabetes, cancer, and heart disease—in order to ensure accurate, risk-adjusted comparisons (apples to apples, so to speak). Thus, you—and everyone else in your practice—become increasingly effective, because you’re all practicing evidence-based care. And your patients will see and feel the difference. All it takes is a little analysis of the work you’re already doing.

It Ensures Financial Viability

Up until now, many therapists have shied away from data collection in fear that it would negatively affect their payer contracts—and thus, their earning potential. And that fear wasn’t totally unfounded, because for the most part, the data collection that was happening was totally out of rehab therapists’ control. Thankfully, that’s no longer the case. With outcomes tracking, the rehab therapy community has a unique opportunity to highlight the value they bring to the table—especially in terms of downstream cost savings.

Once therapists have collected a substantial amount of data, they can leverage it to negotiate better payment rates, increase referrals, and even advocate for policies that will ensure therapists aren’t left behind as payment structures evolve. And the more data the rehab industry can gather, measure, and convert into meaningful information, the more influence it’ll have over the future of health care.

It Establishes PT-first Pathways with Payers

Speaking of the future of health care, outcomes tracking provides physical therapists with the data they need to show payers the benefit of prioritizing PT-first care paths. A 2018 study conducted by Boston University—and co-sponsored by insurance heavy-hitter UnitedHealthcare and the APTA—unearthed some powerful data regarding PT’s unique role in increasing function, improving chronic pain, and keeping pain patients off prescription opioids.

In a separate 2019 study, researchers found that low back pain patients who started their episodes of care with physical therapy were significantly less likely to have short- or long-term exposure to opioids. Add to that the immense cost of prescription opioids and the amount of money insurance payers spend on them each year, and it becomes clear that payers simply can’t afford to not establish pathways to physical therapy as a prescription painkiller alternative. And that’s exactly what payers like UHC have done in response to this data. As impressive results like these continue to come down the pike, other payers are sure to react as well.

It Keeps a Pulse on Patient Satisfaction

Patient feedback and results also allow you to manage the quality of care your patients are receiving. By collecting this information, you can ensure you’re meeting and exceeding patient expectations—and you can proactively course-correct when issues exist. Plus, it will give you the opportunity to identify specific patients who have reported less-than-stellar satisfaction scores, so you can address those ratings head-on—before patients share their unpleasant reviews with friends, the Internet, or their physicians.

According to a benchmarking study published in a 2008 edition of The Journal of the American Physical Therapy Association, “Measuring health care quality (i.e., outcomes assessment) and comparing providers’ performance using those measures of quality (i.e., provider profiling) are important strategies for making providers accountable for the care they provide.” Furthermore, more than 90% of the survey participants who used standardized outcome measures agreed that those measures enhance communication with patients and help direct their plans of care.

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How do I integrate outcomes tracking into my current workflow?

Adjusting for Risk

Clinic comparisons based on case-load efficiency don’t provide a full picture, because they don’t account for case and patient mix. To truly measure the quality of care, you must use patient outcomes data—more specifically, risk-adjusted patient outcomes data. After all, only then can you truly assess the effectiveness of therapeutic intervention. When you don’t account for complicating factors, the quality of your data—and any insights drawn from it—are at best, incomplete and at worst, erroneous. As this study from the Journal of the American Physical Therapy Association explains, “assessments of provider performance that are tried 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 can practitioners account for these complicating factors consistently and in a way that scales with a growing business? By using risk-adjusted outcome measurement tools (OMTs). According to this overview 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.” Risk-adjusted OMTs allow practitioners and payers to establish benchmarks for monitoring the quality and efficacy of care over time—internally and across clinics, regions, and the nation.

For these reasons, we recommend seeking out outcome measurement tests that account for factors contributing to patient complexity, including age, weight, litigation, diabetes, and heart disease.

Understanding the Tools

Here are some of the most widely accepted risk-adjusted outcome measurement tools for physical and occupational therapists, as well as some guidance on when to use them:

1. Dizziness Handicap Inventory: Designed to evaluate self-perceived effects of dizziness, this self-assessment is relevant when assessing vestibular and balance vestibular, gait, quality of life, and social relationships. Learn more about this OMT—including information about the populations tested and the standard error of measurement—here.
2. Modified Oswestry Low Back Pain Questionnaire: Clinical practice guidelines recommend this tool—also known as the Oswestry Disability Index—be used as an accurate and validated measure of a patient’s pain, function, and disability. Practitioners use the assessment to measure the degree of disability and estimate the quality of life for patients with low back pain. (The modified version replaces sexual activity questions with questions about recreation, thus making the tool more applicable to a wider range of respondents.)
3. Neck Disability Index: A variation of the Oswestry, the Neck Disability Index (NDI) is the most commonly used self-assessment for measuring the severity of neck pain (i.e., how neck pain is affecting a patient’s everyday life). It’s commonly used when evaluating chronic neck pain, cervical radiculopathy, headaches, and whiplash injuries, and associated disorders.
4. QuickDASH: With only 11 questions, the QuickDASH is an abridged version of the DASH (Disability of the Arm, Shoulder, and Hand) test, which measures physical function and symptoms of people with upper-limb musculoskeletal disorders. With this self-assessment, patients with one or more upper-extremity musculoskeletal conditions rate functional difficulty and interference with daily life on a five-point Likert scale.
5. Lower Extremity Functional Scale (LEFS): In this self-reported questionnaire, patients rate how difficult it is to perform everyday tasks. Practitioners commonly use this OMT for lower-extremity cases.
6. Modified Falls Efficacy Scale: This 14-activity questionnaire is an expanded version of the original Falls Efficacy Scale, which does not include outdoor activities.
7. Berg Balance Scale: This widely-used clinical test assesses an individual’s static and dynamic balance abilities, as well as his or her subsequent fall risk.
8. Pelvic Floor Distress Inventory: Designed to measure the degree of disruption to quality of life caused by pelvic floor disorders, this questionnaire has 20 items and three separate scales.
9. Foot and Ankle Ability Measure: This self-reported outcome measurement assesses the level of function in patients with foot and ankle disorders.
10. Bates-Jensen Wound Assessment: Originally developed in 1990 and revised in 2001, this assessment evaluates 13 wound characteristics and rates them from best to worst using a numerical scale. According to this resource, “This tool is recommended for assessing and monitoring pressure ulcers and other chronic wounds.”
11. Knee Injury Osteoarthritis Outcome Score (KOOS): This knee-specific questionnaire assesses the patient’s opinion about his or her knee and associated problems. Therapists can use the KOOS to evaluate the knee injury and treatment outcomes throughout the course of care.
12. Hip Disability Osteoarthritis Outcome Score: This questionnaire assesses the patient’s opinion about his or her hip and associated problems. Providers can also use this outcomes questionnaire to evaluate symptoms and functional limitations related to the hip throughout the course of therapeutic care.

Administering OMTs

How you distribute your tests is totally up to you and your clinic’s leadership team. However, we recommend having patients who are completing a patient-reported outcome measure (PROM) for the first time do so in the clinic—perhaps in the waiting room immediately following check-in. That way, if they get stuck or have questions, help is nearby. For follow-up surveys, you could mail or securely email the test to the patient in advance and instruct him or her to bring the printed and completed survey to his or her next appointment. Either way, to preserve the integrity of the test and the accuracy of the responses, we do not recommend therapist participation in administering PROMs. Patients should complete the tests independently to ensure that they do not feel pressured to answer in a certain way.

Educating Patients

For your clinic’s patient-reported outcomes data to be meaningful, patients must complete the tests honestly, accurately, and completely. Thus, it’s imperative that you educate patients on:

1. How to complete each questionnaire,
2. How you will use their responses, and
3. How their participation benefits them.

In addition to ensuring that you know the answers to these questions, we recommend including an introductory paragraph at the top of each test, explaining its purpose. Here’s an example:

Please complete this survey as thoroughly and honestly as possible. There are no right or wrong answers, and while some items may be more relevant to your case than others, we encourage you to answer all questions. Your responses will provide insight into how we’re doing and how we can better help you progress toward your goals. Your individual survey information will be shared with our care team only.

By educating patients about outcomes tracking, you’re also opening the door for those patients to become more actively involved in their treatment—something that could, in turn, improve their outcomes.

Setting Expectations

If you have a history of patients stopping therapy before the end of treatment or consistently skipping home exercises, it might be time to review the expectations you are setting. It’s not enough to provide patients with information about treatment decisions at the beginning of care and then assume that they’ll stay committed to the plan. Therapists also must set the expectation that therapy works when and if the patient remains actively involved throughout the entire recovery process. Patients should not only understand their treatment options, but also know what they need to contribute to the process and what outcomes they should expect. That way, everyone understands the goal and how to reach it.

Also, be sure to set a test administration schedule so you’re collecting valuable information at relevant points in the treatment process without inundating the patient—or yourself—with unnecessary forms. Don’t administer OMTs at every visit. Do complete them on a schedule that makes sense, and always perform an outcomes assessment at discharge or at the conclusion of treatment so you and the patient are able to quantify the improvement that’s been made.

To learn more ways clinicians can help patients take a more active role in their treatment, check out this blog post.

How do I overcome barriers to outcomes collection?

If you’re still feeling somewhat resistant to outcomes collection, that’s okay. Here are three of the most common barriers we’ve come across—and some advice for overcoming them.

1. It takes too long for patients to complete the measures.

Adding an extra to-do to your workflow is tough, especially considering that your schedule is already jam-packed. Of course, any workflow change is going to create some short-term bumps in the road. But, once you’ve streamlined everything to ensure your outcomes tracking processes are optimized for efficiency, the key to outcomes tracking success is making the extra time spent on this endeavor actually valuable to the patient.

That means you can’t just collect responses from patients, file them away, and be done with it. Instead, cite that data as the patient progresses. That way, the patient sees value not only in the data collection itself, but also in the treatment. It’s like a two-for-one—and we’re betting it’ll actually increase the patient’s satisfaction with his or her care, therapist, and clinic. Plus, it gives the patient a means of actively participating in his or her care—making him or her feel even more invested in the treatment. Suddenly, treatment becomes a two-way street—and that’s good for both outcomes and patient experience.

2. Outcomes questionnaires are confusing.

First, be sure the tests you’re administering are widely used and accepted, as they’ve most likely been optimized for patient use. Second, make sure everyone who’s involved in outcomes collection completely understands the tests so they can answer any questions patients may have. If you’re having patients complete the tests on their own, provide an FAQ with answers to questions you’ve received from other patients. And always make yourself—or someone else in your clinic—available to help. These interactions could turn into meaningful, positive interactions with your patients. And that, in turn, could increase those patients’ satisfaction levels.

3. Cognitive biases can skew outcomes collection and results.

It’s easy to unconsciously tailor the outcomes measures you collect to flatter your practice—or to dismiss the negative results as outliers that don’t tell the full story. But if you’re only picking and choosing what you want to see when it comes to outcomes, you’re not getting an accurate picture of the quality of care you’re providing. In this blog post, Zach Walston, highlights some of the biases clinicians may fall into when creating and examining outcomes measures, including:

• Confirmation bias;
• Theory-induced blindness;
• Availability bias;
• The “halo effect”; and
• The sunk-cost fallacy

The key, as Walston highlights, is to be aware of these potential biases is to be aware of them so that you can better avoid falling into those traps as you implement outcomes measures in your practice.

What are some frequently asked questions (FAQs) about outcomes tracking?

Successful Outcomes Tracking

How do I incorporate outcomes data collection into my workflow?

We believe incorporating data collection into your practice’s clinical workflow is a five-step process:

1. Make sure everyone—from front office staff and billers to assistants and therapists—understands why your practice is collecting outcomes data.
2. Involve everyone in planning and implementation.
3. Educate your patients.
4. Establish a process for administering OMTs.
5. Identify those people within your practice responsible for each outcomes tracking step.

What are the benefits of outcomes tracking?

There are tons, but here are the big ones. Outcomes tracking enables you to:

• Improve patient care.
• Better market yourself and your practice.
• Influence payment rates.
• Maximize performance.
• Position yourself and your peers as key healthcare players.

How do I ensure patients complete their OMTs?

Put simply, you can’t have a successful patient-reported outcomes tracking program if your patients don’t report their outcomes. Thus, honesty and accuracy are paramount, and to ensure both, you must educate your patients.

How often should I collect outcomes data?

The frequency at which you collect outcomes data ultimately is up to you and your clinic. However, most WebPT Members collect this information on a monthly basis. This ensures that:

• the data is accurate and up to date, and
• the patient has enough time to show progress.

At the very least, basic payer compliance standards for proper outcomes reporting constitute an initial outcomes encounter, a progress encounter, and a discharge outcomes encounter.

Can PTAs enter outcomes data?

Yes! Anyone who can access and edit patient documentation—including PTAs—can enter outcomes values. But, keep in mind that, depending on your state’s regulatory requirements, your PTA may not be able to finalize the documentation.

How much extra time will we spend tracking outcomes?

The best outcomes tracking solutions are built with therapist efficiency in mind, so be sure to look for one that is integrated with an excellent PT-specific EMR. That way, you’ll be able to enter outcomes data as part of your standard documentation. After a patient completes the OMT, the therapist can easily tab through the entry form and input the answers. This should take approximately 30 seconds.

The Data

How long will it take to collect enough outcomes data to identify trends and draw conclusions?

Identifying trends and drawing meaningful conclusions from your data takes time. How much time depends on the number of patients you see for a particular diagnosis that has a corresponding outcomes test. We estimate that you’ll need to collect outcomes for a minimum of 25 patients before you start analyzing your outcomes data. So, once your clinic sees 25 patients with, say, a primary diagnosis of lumbar spinal stenosis, you should be able to run reports and gain valuable insights (we estimate that it will take roughly two to three months for a small clinic to see that many lumbar spinal stenosis patients). So again, your clinic’s outcomes timetable ultimately depends on your specific patient counts.

How do we get outcomes data in front of payers?

It’s up to clinics to aggregate their data and present it to payers in a meaningful way during contract negotiations. Outcomes tracking software helps therapists effectively demonstrate their value by providing objective data in easy-to-digest reports and graphs. As seen with value-based reimbursement models adopted by CMS—like MIPS (or merit-based incentive payment system)—outcomes reporting is a requirement and will be directly tied to positive or negative financial bonus adjustments.

How is WebPT making outcomes tracking easier?

WebPT Outcomes

WebPT Outcomes is the only fully integrated outcomes tracking solution for physical and occupational therapists. It allows therapists to input and track the results of outcome measurement tests. And, because it’s integrated directly with WebPT, the reports are stored within the patient record—so you can see outcomes data analysis for information you most likely already record within your documentation. When you use our outcome measurement tools, the functional limitation values will display within your documentation next to the corresponding current and projected goal statuses.

The Benefits

WebPT Outcomes provides users with integrated patient surveys and comprehensive reports; industry-standard, reputable outcome measurement tools; and visual dashboards and detailed comparative summaries. With WebPT Outcomes, you’ll be able to:

• Collect, monitor, and compare outcomes data from every patient, for every therapist, in every clinic—all within one system.
• Access a diverse library of evidence-based, industry-accepted tests that are already familiar to—and respected within—the healthcare community at large.
• Ensure accurate, risk-adjusted comparisons across patient types with risk-adjusted tests that account for complicating factors (i.e., comorbidities) such as age, weight, litigation, diabetes, cancer, and heart disease.
• Improve overall patient care—as well as therapist, clinic, and company performance—with a library of visual reports that make it easy to identify and monitor trends.
• Embed OMTs on your website or send them via email. Patients can then complete the tests prior to their appointments, saving you time and preserving test objectivity.

Own your data.

Ever felt like the results your patients are achieving don’t match up to the statistics your payers bring to the negotiation table? Now you can prove them wrong.

Hold yourself—and your staff—accountable.

WebPT Outcomes provides users with the means to set concrete therapist-and clinic-level performance goals and track progress toward them.

Drive patient satisfaction.

WebPT Outcomes gives your clinic the tools you need to give your patients what they want: a faster road to recovery.

Never toggle again.

Double data-entry is never worth the time—or the risk. With our seamlessly integrated outcomes tracking solution, you’ll save yourself the hassle (and the errors).

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Want to up your outcomes game?

Learn why WebPT Outcomes is the top outcomes tracking solution for PTs and OTs.