Implementation and Management of Outcomes

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Implementation and Management of Outcomes

• Katherine Scott PT

QM Coordinator Presbyterian Rehab Services
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• Define need for Outcomes management
• Define process to obtain staff buy in
• Use of Outcomes data for management
• Clinic management
• Clinician management
• Contract management

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Outcomes Management

• the process of collecting, compiling, and
  analyzing the effectiveness and efficiency of
  patient treatment for the purpose of reducing
  unexplained variations in clinical care,
  improving quality and lowering cost
• -Ed
  Dobrzykowski

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Components of Outcomes Measurement

• Effectiveness
• Patient health related quality of life
• Patient satisfaction
• Patient functioning

• Efficiency
• Resource utilization
• Number of visits
• Length of stay
• Cost

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Getting Started

• Take the Next Step...
• Where do you want to go?

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• Unless you are willing to incorporate
  outcomes into the life blood of your
  clinical practice and day to day operations,
  then dont waste your valuable resources
  with merely collecting data.

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• Set the Philosophy for Outcomes Management for
  Rehab Services
• Weave Outcomes Management into the very fabric of
  every aspect of Rehab
• Accountability of all staff, coordinators, and
  directors for the Outcomes process
• Demonstrate support for the Outcomes process from
  upper level management

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• Set the Philosophy for Outcomes Management
  for Rehab Services

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• Initial Philosophy for Outcomes Management of
  Rehab Services
• Oryx Initiative
• Just one more thing

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• Outcomes Management is not a separate issue in
  the Big Picture of Rehab, it is very much an
  essential part of the financial picturebecause
  of our financial picture, we must manage Outcomes
  and change our Clinical Practice.

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• Weave Outcomes Management into the very
  fabric of every aspect of Rehab

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Clinician Productivity
Clinician Outcomes
Clinician Compliance
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Clinician Productivity

• New evaluations seen
• Recurring visits

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Clinician Outcomes
Stars
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• Clinician Awards
• Clinician Data
• must make all data available to staff
• must be willing to take the time to help staff
  understand data
• must define clinicians role based on the data
• their role for the benefit of the team

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Standards of Care- Best Practice

• Challenged by physician re shoulder outcomes
• took a hard look at our Stars and our shoulder
  outcomes
• pulled dedicated team of PTs and OTs together
  gtgtgt Stars

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Standards of Care- Best Practice

• Shoulder Committee
• Developed standardized evaluation/tests
• Developed practice guidelines/protocols for most
  common diagnoses
• Presented inservices to all therapists

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Standards of Care- Best Practice

• Reassess shoulder outcomes at 6, 9, 12 months
• Staff very receptive
• Looking at other diagnoses to address the same
  way

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Utilization ReviewRe-Authorization

• Streamline patient authorization process
• reduction of time spent on authorization and
• re-authorization process
• eliminated breaks in the provision of care
• continued therapy based on actual patient outcomes

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• Whenever you blaze new trails, you are bound to
  come across a few rattlesnakes.
• - Jon
  Banks
  
  
  Director PHS OP Rehab
• 
  

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OUCH !

• Quarter 1, 2000 to Quarter 1, 2001
• 15 decrease in Visits
• 18 decrease in Outcome Index scores vs. FOTO
• Clear delineation between first 6 months and
  second 6 months data

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What Happened ?

• Special Analysis of Data
• no one factor identified as culprit
• All staff had a drop in outcome scores
• new staff had highest outcomes
• only identifiable process that changed
• implementation of UR/Re-Authorization process
• implementation of CADI

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Discovery

• Staff had not bought into the UR process
• perceived the process as us versus them
• discharged the patients rather than taking the
  time to complete a Patient Status survey and
  submit the form for additional visits
• sabotage of process by a few clinicians

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Solution

• Urgency of situation shared with staff
• need to increase length of stay
• need to increase number of visits
• Revision of number of visits for initial
  authorization of care
• Change in staff

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Where are we today ?

• Quarter 2, 2001 reveals upward trend
• increased number of visits
• improved outcomes
• no impact on patients from other payers
• Still bleeding but hopeful with release of
  Quarter 3, 2001 data
• Payer response to decreased Outcomes

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• Accountability of all staff, coordinators,
  and directors for the Outcomes process

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Clinician Compliance with FOTO

• Information provided quarterly
• Number of new evaluations
• Actual number of patients in Statistics and
  Outcomes sections of therapists quarterly report

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Clinicians Opportunities for Improvement

• All therapists data available to all staff
• Set three goals for improvement
• Compliance with process
• Change in clinical practice patterns
• Increase knowledge base for treatment
  interventionsgtgtgtask the stars
• Part of annual review process

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Clinic Coordinators Response

• Keep benefits of Outcomes at the forefront of
  every staff meeting
• obtaining/maintaining contracts
• how critical business decisions were based on
  outcomes
• encouragement of small gains

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• Demonstrate support for the Outcomes process
  from upper level management

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• Director of OP Rehab
• Jon Banks - a member of the FOTO choir
• must provide quality close monthly
• Director of Clinical Ancillary Services
• fully supports use of outcomes
• expects outcomes data in decision making process
• Upper management
• sharing what Rehab is doing with Outcomes

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Words of Wisdom(from the School of Hard Knocks)
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• Continue to educate about the need for Outcomes
• tell them FOTO is not going away
• Deal with sabotage immediately
• aim for consensus to the process
• Find ways to simplify/streamline the data
  collection process

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• CADI
• reduction staff time
• improved compliance with process
• valuable reports
• Get quarterly data to staff
• timely manner
• understandable format

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• Establish accountability standards
• Compliance
• Outcome scores
• Patient Satisfaction

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• Unless you are willing to incorporate
  outcomes into the life blood of your
  clinical practice and day to day operations,
  then dont waste your valuable resources
  with merely collecting data.