As a baseball fan I am quite familiar with the ridiculousness of some sports statistics. Just this morning I was looking at the baseball section on ESPN.com and learned that Michael Fulmer of the Detroit Tigers was recently the first Tiger’s pitcher to throw a four hit shutout with no walks and 9 strikeouts since Mickey Lolich in 1971. I also learned that the Chicago Cubs haven’t hit five home runs in a home win against the St. Louis Cardinals since 1956.
Anyone who follows sports has heard numerous of these statistics that have been generated by back room television and newspaper research teams that basically mean little other than the intent to hyperbolize the importance of an individual or team performance.
There are numerous statistics in the Workers’ Compensation Physical Therapy world that, like the baseball statistics above, are nice but aren’t necessarily meaningful.
Frequently I hear “We Average XX visits per referral!” The response to this statement should be, “So what?” What type of progress did the patient make at discharge? Was the patient actually better? Did they demonstrate any functional improvement and go back to work at regular duty? Or were they sent on to another specialist or for more imaging or for another procedure (surgery) and then potentially back to therapy?
Even more frequently I hear “We can get you a XX% discount off the fee schedule or a flat rate of $XX per visit!” or “We can offer a case rate of $XXX for every patient with this diagnosis code!” A discount is nice, I like discounts. But what does this mean? If the patient is not getting better it might as well be free.
These attitudes have driven the commodity-based approach to Physical Therapy that Workers’ Compensation has come to accept. Quantity over quality. Price over value.
The non-comp world is changing and in the future we will see reimbursement structures based on service value over service volume. Physical Therapy practices will need to demonstrate meaningful outcomes to maximize or even justify reimbursement. It should be no different in Workers’ Comp.
Those making decisions in regards to where to send injured workers for Physical Therapy should be cognizant of the value their providers can demonstrate. Certain data points like amount of functional improvement per visit, patient satisfaction and total case duration are more important stats to know instead of how many visits were used and how much did each visit cost. Oftentimes a low average number of visits per case can actually be a bad sign. I frequently see less experienced therapists average fewer visits per referral than senior therapists.
If a patient or physician thinks Physical Therapy is not working they are more likely to cut it short and try something else. And as stated previously it doesn’t matter what the visit costs if the patient is not improving.
A Physical Therapy group that can offer extremely low cost per visit has to cut these costs somewhere – using non professional staff to provide care, not offering continuing education benefits or putting burdensome productivity standards on their Physical Therapists. These practices that are necessary to deliver extremely low cost per visit can ultimately lead to poorer functional outcomes.
Quality outcomes measures should evaluate functional improvement, patient satisfaction, case duration and visit utilization in patients while comparing patients to similar patients through a risk adjusted database. These outcomes then can compare organizations, clinics and individual therapists to their peer groups. Workers’ Compensation decision makers should seek out these top providers; as utilizing quality Physical Therapy practices has demonstrated decreased utilization of opioids, physician visits, surgery and injections. These services are typically much more costly than Physical Therapy and can frequently be avoided when choosing the highest quality, not the cheapest, Physical Therapy providers.
Physical Therapy organizations should be measuring outcomes and their impact on the total cost of patient care. Consumers of Physical Therapy, including Workers Compensation stakeholders, should look at the outcomes measures with skepticism and ensure that what is being provided is meaningful and demonstrates value.
