Written by Sara McEvoy, PT, DPT
A major change is happening in today's healthcare system, and its effects can be seen in a variety of clinical settings—the transition of payment models from fee-for-service to value-based reimbursement.
Instead of being paid per visit or service—regardless of whether the service or visit was effective—more and more clinicians are being reimbursed through insurance companies based on the quality of their patients' clinical outcomes.
There are several proposed benefits to this new reimbursement model. For one thing, providers are being incentivized to affect meaningful and effective change for their patients—beyond (we hope) the intrinsic incentive of serving others and doing no harm, which we can only hope is alive and well in healthcare professionals!
Also, survey data and research also indicates that value-based reimbursement models lower overall healthcare costs and improve the quality of care, as reported by publications such as the National Business Group on Health. Value-based reimbursement has also been suggested to promote greater innovation, evidence-based medicine, and interdisciplinary collaboration.
Naturally, this switch to value or outcome-based reimbursement puts an increased responsibility on clinicians. After all, if healthcare providers must be able to show that their visits and services are improving their patients' outcomes, then how must they measure and document these outcomes in the first place?
The sort of objective data-tracking that is required for a successful value-based reimbursement model is especially important for physical therapists (PTs) and other rehabilitative professionals. Why? Because their main outcome measures tend to be more abstract than other professions.
Instead of relying on lab tests and radiographic imaging, for instance, therapists often cite the change in a person's function in order to determine the degree to which their services are effective. Function includes walking, transferring, getting in and out of bed, negotiating stairs, and getting dressed.
One primary method is through the levels of physical assistance. This is a standardized way to assess how much of a given functional task or activity of daily living (ADL) a patient can do on their own, and includes terminology such as "modified independence" (the patient can do a task on their own but may need extra time, adaptive equipment, or other modifications to do so safely) and "minimal assistance" (the patient can do at least 75% of the task and requires up to 25% physical and/or cognitive assistance from a helper).
Physical assistance levels—captured in the rehabilitation setting as a Functional Independence Measure, or FIM score—can also be used to monitor and reflect a change in status throughout the course of a patient's plan of care.
In addition to levels of assist, the following data points are some of the most common ways that PTs and other rehabilitative clinicians can track patient progress and measure outcomes:
What the majority of these objective measures have in common is that their psychometric properties have been studied and standardized. These properties may include:
This type of standardization matters immensely. It creates a "common language" that can be understood by different team members involved in a patient's care. It also can be used to show insurance companies the degree of objective and effective improvement made in a patient's outcomes as a result of the services and care provided (and therefore render reimbursement).
To be clear, subjective data such as patients reporting that they feel better than ever is important in the clinical picture, too. But the reality is, objective measurements must be regularly documented if clinicians expect to get paid for their care and avoid the headache of reimbursement denials.
In light of this last point, any valid and reliable tool that a PT or other clinician can use to help objectify and standardize their data—especially more abstract and imprecise data such as walking—is highly valuable.
Walking—known clinically as gait or ambulation—is an essential diagnostic, predictive, preventive, and even prognostic indicator for clinicians within the rehabilitative field of healthcare. Gait has actually been referred to in the literature as the "functional vital sign." Measured appropriately, walking can help therapists and other clinicians identify people who are at risk for falls and monitor people's overall health.
The problem, of course, is that without objective tools, walking can be hard to translate into objective data!
Tracking walking speed and distance, for example, may not always be feasible in the clinical setting. For example, a patient may require physical assistance, making it impossible or unsafe for the assessing therapist to operate a stopwatch at the same time. In the busy clinical setting, it may also be an unproductive use of a therapist's time to have to go back and physically measure the distance walked with a measuring wheel, tape measure, or other imprecise tool.
To address these potential inaccuracies and inconveniences, devices such as the Accutrax and AmbuTrak prove highly effective.
The Accutrax is a digital distance tracker that installs easily to the base of most walkers. The upward-facing, bright digital screen allows for both clinicians and patients to easily monitor the distance covered (in meters and feet). Patients can use this tool as motivation to meet or surpass their daily walking goal, while clinicians can use the data to modify plans of care accordingly. No more "estimating" distances, relying on old blueprints of hallways and walkways, or going back to re-measure (and remember!) how far patients ambulate.
The Ambutrak is a simple way to measure walking distance and speed for patients in a variety of settings (skilled nursing facilities, inpatient rehabilitation hospitals, home health, outpatient physical therapy, schools, etc.). It's easy to install on any standard 2-wheeled walker, and clips to the upper section of the walker, for an easily visible screen. Recording objective data (distance in feet and speed in miles per hour) becomes both easy and accurate, even within the normal time constraints of a busy clinic.
These tools can be invaluable for a variety of matters that PTs and other rehab professionals are involved in, including screening, fall prevention programs, and discharge planning—especially for community-dwelling older adults.
For instance, did you know that research shows a person needs to be able to walk about 1.32 meters per second (or just under 3 miles per hour) in order to safely cross the street? With this in mind, it should be clear why objective walking tools like Accutrax and AmbuTrak can make such a difference for patients and clinicians alike!
Do you have questions about the products your clinic could use to measure patient outcomes more objectively? Are you having trouble capturing the positive impact you're making on your patients' health and quality of life?
Visit Rehabmart.com if you'd like to learn more about Accutrax, Ambutrak, and other tools and services that can enhance your patient care. And, for more helpful articles just like this one, check out our full library of resources at Caregiver University.
Sara McEvoy, PT, DPT, is a licensed and board-certified Doctor of Physical Therapy. She has direct clinical experience within the long-term acute care and skilled nursing settings, and has a special interest in geriatrics and neurological rehab. She is also a freelance writer who creates content almost exclusively within the health and wellness fields.
