Variability is Bad for Physical Therapy
In health care, there is an inverse relationship between the number of treatments available for a given condition and our ability to effectively treat the condition. Effective early immunization has nearly eradicated polio, most bacterial infections are still responsive to broad spectrum antibiotics, and our ability to repair ligaments surgically has resulted in patients having the very reasonable expectation of returning to previous functional levels.
The High Cost of Inconsistency
Physical Therapists have historically valued different ‘approaches’ in our clinics. Depending on which therapist a patient with low back pain sees, he/she might be exposed to a Pilates-based approach, extension exercise progressions, joint mobilizations and manipulations, active release therapy, core stabilization, or any of a hundred other approaches. This is not in the best interest of our profession or the long-term success of your business.
We are moving toward a value-based payment model, and each of us needs to be prepared to answer questions that surround clinical outcomes, the customer experience, and the cost-effectiveness of our care versus other therapists and other professions. In addition to those questions, we also need to be prepared to answer the next logical question when we tout that our results are unmatched in the marketplace: “Why?”
What healed Larry?
Returning to our low back pain patient…we’ll call him Lumbar Larry. When Larry comes in for his first visit and sees Kim, she evaluates, diagnoses, and prescribes a course of care for Larry aimed at restoring his function and decreasing pain via an aggressive core stabilization program with targeted stretching. Five visits later, Larry is approximately 50% better, but Kim has transferred to another facility. His new PT is Luke, whose training and beliefs (and Larry’s subsequent visits) focus on joint mobilization and manipulation with extension based mobility exercises. After 5 more visits, Larry is 100% better, and can’t say enough good things about your practice. If you hear this story and think it’s good, I respectfully disagree.
No one, including Larry, has any idea what got him better. If he had continued the first course of care all the way through, would his result have been better, worse, or the same? Maybe it was a stroke of genius to shift his POC when we did, but there is no objective way to evaluate this. We only have a ‘gut feeling,’ and if we are relying on only that to make decisions for our companies and profession, we are in trouble.
Demonstrating PT Value
When your insurance carrier contracts expire, and you look to renegotiate them, you need to be able to walk into that meeting and state unequivocally, “This is what we do. This is how we do it. This is what we can do for you.” These statements can’t be based on what you think or feel, they have to be based upon concrete, incontrovertible data. EMR companies like Clinicient are making it easier than ever for us to look within our own organizations and begin to demonstrate the value that we provide through metrics and analytics, but it is up to us to create the clinical and operational environment that produces consistent repeatable data that can be analyzed in aggregate.
Larry got better, and that is awesome! We need to be able to accomplish this for the next 1,000 patients that walk in our door, too. When each of those patients gets grossly different care, we will never be able to use the data being produced to tell a story about why Larry and his whole lumbar family should #ChoosePT.