Predictive physical therapy: can questionnaires aide prognosis?

There is a new age of accountability (financial, regulatory and otherwise) in physical therapy.

Some examples...

Physical therapists are being asked to work and get paid based on their productivity rather than a fixed salary.

Medicare requires physical therapists to 'diagnose' their patients using objective, public-domain tools, like the OPTIMAL scale.

Now, physical therapists can predict whether patients will adhere to physical therapy after spine surgery. The test is called the Patient Activation Measure (PAM) questionnaire.

"Essentially, the test places patients on a continuum of activation ranging from those who don't see an active role on their part as necessary to those who are highly motivated to take an active role in their own health care." said lead author Richard L. Skolasky, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

My professor in physical therapy school once told me that questionnaire data was 'soft' and that we needed 'real numbers' for good decision-making in physical therapy. In 1992, my professor called questionnaire data 'subjective' data.

Well, that was 1992 and this is 2008.

In 2008 and beyond, more of our physical therapy data will come from questionnaires. The good news is this... questionnaire data is good data.

The test that is destined to replace the OPTIMAL scale is the Activity Measure for Post Acute Care (AM-PAC). The AM-PAC produces good data.

Data is going to be necessary for physical therapists to demonstrate value to payers.

In 2006, the single largest purchaser of health care in the world, US Medicare, spent $3.06 billion on physical therapy.

Questionnaires can give us good data.

Good data can improve physical therapy accountability, diagnosis and prognosis.

What Alternatives for Physical Therapy?

The Outpatient Therapy Payment Alternative Project Synopsis is at the point of data collection...

"In order to collect the needed data, the project involves (1) the development of a data collection strategy, including the recruitment of therapy providers to participate in data collection..."

The Project needs to collect data on how to measure the patients you see in physical therapy every day.

Medicare would like to know three things

1. How disabled are they?
2. How much will they improve with physical therapy?
3. How disabled will they be at discharge?

"The Medicare Payment Advisory Committee (MedPAC), the Government Accountability Office (GAO), and outpatient therapy stakeholder organizations have suggested that the claims and administrative data currently available to CMS are not sufficient as the basis for developing better alternatives to the therapy caps."

Right now, the data collection instrument looks like it will be the Activity Measure for Post Acute Care (AM-PAC).

"the AM-PAC was designed to be used across patient diagnoses,
conditions and settings where post acute care is being provided"

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I currently use the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) and I like it.
This project may dovetail with other projects ongoing at Medicare.

The Physician Quality Reporting Initiative (PQRI), affectionately known as Pay for Performance (P4P)may become a part of the Alternative Payment Model.

The American Physical Therapy Association (APTA) is working on a payment model (an alternative to the 'Alternative') that will pay providers more when the patient gets better in less than the expected number of visits.

"Value Purchasing in Outpatient Physical Therapy" by Alphonse Amato, PT, MBA in 2006 laid out a similar-sounding plan.

Go read it.

It sounds like a blueprint for the future.

Depends on who gets their way.

Cut Medicare to Increase Physical Therapy Value Proposition?

American Physical Therapy Association applauds Senator Max Baucus for standing up against efforts to abolish the Automatic Exceptions Process to the Medicare Physical Therapy Cap.

The Automatic Exceptions Process is an essential mechanism to assure that physical therapy services are accessible by the people who need it most.

A recent study ordered by the Centers for Medicare and Medicaid Services (CMS) found that, due to the cap, for the first time since 1999 the cost and the growth in physical therapy expenditures declined during 2006.

The... "study reveals that from CY 2004-2006, although the total number of therapy users continued to increase by 3.5% the overall expenditures actually decreased 4.7%.

This represents the first observed negative growth in payments per beneficiary since the implementation of the therapy caps during CY 1999."

Further, the intended effects of the Medicare cap appeared to be met since the number of beneficiaries accessing physical therapy services actually increased in 2006 by 3.5%.

The mean payment per physical therapy user declined 8% in 2006.

The Medicare cap, first implemented in 1999, is the attempt by Medicare to limit the growth in federal physical therapy expenditures.


The Value Proposition


Medicare would like to measure the value for its health care dollar.

In 2006, Medicare spent $3.05 billion dollars on physical therapy.

From 2002-2004, the growth rate in expenditures was 26%.

The Medicare value proposition is Value = Quality / Cost.

Cost is easy to measure (see above).

Quality, however, is not.

Current projects, like Pay for Performance (P4P), are Medicare's attempt to measure quality.

Too many physical therapists dismiss attempts to measure quality.

What are we afraid of?

Al Amato, PT, MBA replies to a statement by made on August 12, 2007 by Larry Benz, PT that "P4P ...is a fad":

"The momentum is moving toward P4P. I think it imprudent that this trend be ignored. At the least, consider collecting outcomes to be able to compare your care to a national average."

Congratulations to Senator Max Baucus. He is taking a tough stance in the short run - standing up for physical therapy.

In the long run, however, Senator Baucus understands that physical therapy provides value to Medicare.

And to Americans.

Find other ways to measure the value of physical therapy.

See How to make a Physical Therapy Diagnosis

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