Is Outcomes Data Actually Meaningless? 5 More Takeaways from the 2015 Graham Sessions.

Yesterday, I shared my first five quotable takeaways from the 2015 Graham Sessions; today, I’ll reveal the second half of my list. As I mentioned in part one—which you can check out here if you missed it—this was the eighth installment of this annual event, which evolved out of a need for PTs to get together and have real, honest conversations about the issues facing their industry. At this meeting, every voice matters. And to ensure that no attendee hesitates to speak his or her mind, organizers have one very important ground rule: If you publicly share any ideas presented during the sessions, do so without attaching names to specific comments. With that in mind, here are the last five sound bites—unattributed, of course—that I feel best summarize the concepts discussed at this year’s Graham Sessions.      

1. “We distrust payers more than payers distrust us.”

Reimbursements are falling—not just for physical therapy services, but for services across the spectrum of healthcare. As PTs fight to protect their livelihoods, many have grown to distrust the insurers behind those declining payment rates—and that has put PTs on the defensive, big time. Why? Well, many physical therapy professionals make the assumption that those shrinking reimbursements are a reflection of the value—and the confidence, respect, and trust—that payers place in physical therapy. Essentially, payers and PTs are locked in a standoff. And, as one speaker noted, “Whoever figures out how to put their distrust aside first is going to win.” But do payers really doubt the efficiency and effectiveness of physical therapy—especially in comparison to more costly treatment options like surgery or pharmaceuticals? According to one Graham Sessions participant, the answer to that question is: not always. “Payers are beginning to understand that increased utilization of physical therapy now will save money downstream,” that attendee said.

But to drive those payers to action—and to obtain the reimbursement rates PTs want and deserve—therapists and clinic owners have to look at the issue from the payer perspective. In one attendee’s words, “We’re not going to solve anything until we get on the same side of the problem.” To do that, PTs must “be willing to step into [the payer’s] world.” Payers base their decisions about rates on concrete data—and if there’s no data to justify deviating from the status quo, then those payers are not going to change how they reimburse. That being said, in many cases, insurance companies are unwilling to go out and get that data themselves. So, to instigate change, PTs have to take the lead; they have to be at the table with meaningful data that supports their payment demands.

2. “The value of data is using it to push wise action.”

Outcomes data collection was one of the hottest topics at this year’s Graham Sessions, and justifiably so. After all, as I explained above, data is a powerful weapon in the fight for change—especially with respect to payment rates. But for PTs to make the information they gather worthwhile, they must be able to interpret it in a meaningful way. It’s not enough to simply collect facts and figures. To drive action—wise action—PTs must be able to take that data and turn it into knowledge. As one speaker put it, “Data is ‘130 degrees of knee flexion.’ That’s data. But it’s not useful without any context around it.”

There are plenty of physical therapists out there who already are collecting outcomes data, and while that is certainly a step in the right direction, very few are using the information they collect for purposes outside of their own clinics. And when they keep all of that intelligence siloed, they miss a great opportunity to inform the decisions that impact the industry as a whole. In other words, PTs—and all other healthcare professionals, for that matter—have to stop collecting data for the sake of collecting data. They have to establish a unified, defined strategy for using that data to effect real change; then, they have to be courageous enough to act on that strategy. As another speaker pointed out, everyone has gotten so focused on getting the answers that they’ve forgotten to ask the questions. And without clear questions—clear objectives for collecting and leveraging data—all we’re left with is a bank of worthless numbers.

3. “We have to embrace standardization.”

Speaking of leveraging data, the overwhelming consensus among Graham Sessions attendees was that the library of outcome measurement tools PTs are currently using is too vast—and too varied—to inform or support any across-the-board initiatives. Regarding that observation, one attendee posed the following question: “If we’re all collecting data on 300 different tests, how do we come up with something meaningful or actionable?” While this problem certainly is not unique to physical therapy, it does seem to be a uniquely American quandary. In one speaker’s words, “We all want to do it our own way, and that’s the American way...we don’t like to standardize.” But if physical therapists continue to resist the establishment of consistent processes for measuring, collecting, and interpreting their data—as well as a uniform set of tools to complete these tasks—then they are not only resigning themselves to losing out on potential payment gains, but also walking away from a huge opportunity to objectively demonstrate the quality of the care they provide. To steer PTs toward sticking to a narrower set of tools, one attendee proposed challenging national associations—namely, the American Physical Therapy Association (APTA)—to provide recommendations on which outcome measures PTs should use.

In addition to eliminating inconsistency in the tools they use to collect their data, physical therapists would be wise to focus on using tools that are recognized and meaningful in a variety of medical fields, especially considering the aforementioned trend toward collaborative care. In one speaker’s words, “Are we doing ourselves a disservice by using tools proprietary to PT only? If we’re talking about encouraging collaboration, how can we do that with tools that only apply to ourselves?” To remain relevant in the wake of the impending transition to a model of episodic care delivery, PTs must be able to clearly show the value they bring to the table as members of their patients’ overall healthcare teams.

Another important piece in the data collection, interpretation, and standardization puzzle: electronic medical records. Ideally, the data collected by PTs and their colleagues in other fields would automatically flow into some kind of national repository that could generate meaningful conclusions. Additionally, in the interest of maximizing the quality and efficiency of care across the provider spectrum, each clinician’s system would be able to “talk” to every other system—thus achieving interoperability. And while this doesn’t necessarily mean that PTs should be using the same EMR software as heart surgeons—in fact, history has proven that large, generalist systems are inefficient and ill-suited to niche provider workflows—it does mean that at some point in the future, all providers, regardless of specialty, will need to use systems that speak the same language. To ensure those systems exist, PTs have to start asking for them—and many already are. As one speaker pointed out, “Our job is to demand it, because software companies will react to that.”  

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4. “Ownership matters.”

Consolidation is something that makes a lot of people in the PT community very, very nervous—and with good reason. After all, PTs worked hard to build a name for themselves in the private practice space following the corporate collapse of the early 2000s. In doing so, they’ve developed a reputation as patient-centered care providers; their focus on building real, human relationships with their patients has served as a major differentiator in the healthcare market at large. Now, rising costs and decreasing revenues are catapulting the industry back toward a landscape of consolidation, with independent private practitioners looking for opportunities to sell, partner, or merge. According to one speaker, “They recognize opportunity in scale. With the increasing complexity in health care...the need for abundant resources is going to be ever more important.” The bottom line: In the next three to five years, we’re going to see a lot of consolidation in the physical therapy industry.

So the question becomes: Is that a good thing or a bad thing? And more importantly, is there any way for PTs to control the impact consolidation will have on their profession? The simple answer is yes, as long as PTs make smart, thoughtful decisions about ownership—because ownership is everything. “In our world, we’ve seen consolidation at all costs—like what happened in the ’90s with physicians—and it didn’t work out because it wasn’t a good fit,” one attendee noted. In other words, it’s crucial that the person at the helm of any large physical therapy practice truly understand the essence of what PTs do—and who better to do that than an actual PT? Of course, as one attendee pointed out, it’s “not insurmountable” to have a non-PT in charge, but it’s “a heck of a lot easier” to have a PT in control.

But not all attendees were willing to accept consolidation—at least in the traditional sense—as the only possible solution to the resource problem and thus, the inevitable evolutionary path of the private practice industry. For example, one speaker brought up the possibility of employing a structure similar to that of a farming co-op, which allows groups of small farmers to borrow equipment and share costs, thus increasing their profit margins. As that speaker explained, this model provides “a way for niche practices to get economies of scale,” thus dispelling the misconception that physical therapy businesses must “grow or die.” Still, the main idea is that market conditions will continue to drive major changes—consolidation or otherwise—within the private practice landscape for the foreseeable future.

5. “Humans tend to think linearly, while technology seems to advance exponentially.”

Technology moves fast, and that makes it tough for PTs—or any other business professionals—to be proactive, rather than reactive, in the way they incorporate and leverage technology to strengthen their businesses. For example, consumers are already using wearable health monitoring devices—things like Fitbits and Jawbones—to help them track progress toward their personal health and fitness goals. Some are even collecting and saving that information using secure online storage services like Microsoft HealthVault and Apple Health. The popularity of these tools among members of the general public represents a major opportunity for healthcare providers—especially physical therapists. Why? Because it could give PTs an “in” at the consumer level:

• What if PTs could access that information and provide data-backed training suggestions to marathon runners or triathletes?
• What if they could use the information to prevent injuries before they happen—by assessing various stress indicators, for example?
• What if that data automatically flowed into a patient’s electronic record, where it could undergo further analysis and interpretation?

Really, the possibilities are endless, and that makes these technologies extremely valuable—particularly to those interested in the direct-to-consumer market. As one speaker put it, “Really what this is, is digital direct access.”

Of course, incorporating new technologies into physical therapy practice raises a number of legal concerns—namely, those related to patient privacy and state licensure. Obviously, not all tech tools available to consumers have the HIPAA seal of approval, so providers have to be careful about the products they use. But participating in a model of online health care delivery—also known as telehealth—gets especially tricky when practitioners provide those services in a virtual setting (i.e., outside of the clinic). For example, to continue with the example of the marathon runner, let’s say a runner in New York wants to receive telehealth services from a physical therapist in Colorado who specializes in treating distance runners. State licensure policy, as it stands, would not allow the therapist to provide those services unless he or she obtained a license to practice in New York. There is an organized effort to change that policy—with some calling for the implementation of a national licensure option. This is just one more reason why now, more than ever, it’s vital that PTs get involved in forming the policy that will dictate the evolution of their profession for decades to come. It’s time for them to stop thinking linearly, and start thinking exponentially.

It’s hard to capture a day and a half of incredibly intelligent, insightful, and meaningful dialogue in just two short—er, short-ish—blog posts, but there you have it: my top 10 takeaways from the 2015 Graham Sessions. Of course, I hope these ideas will spark even more awesome discussion right here on the WebPT Blog. So, the floor is yours: Share your thoughts in the comment section below.