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A Little Look at Big Data Chris Stout, PhD, Vice President Research and Data Analytics
It was nice to come to ATI work with workers’ comp outcomes because… Outcomes are VERY Quantified – RTW at the same job description and PDL or not? – How many days passed before RTW? – Nice, clean, and tidy!
I was always frustrated with the disconnect of collecting PROs in real- time for the clinician (as well as me!)
But we may have cracked the code
Passionate about Patient Satisfaction: Since its inception, ATI has been focused on our mission to provide the highest quality of care in a friendly and encouraging environment. We have the most inclusive, methodologically sound, and productive program in physical therapy. Last year alone, we sent out 222,354 patient satisfaction surveys and received 55,082 in return (a 25% response rate). • Each day, returned surveys are scanned into our IT infrastructure and are immediately available to the Clinic Director and Operations Leadership. This allows the Clinic Director to share praises with the staff, as well as address anything that is not exceeding expectations related to quality of care or customer service. It is a concrete example of how the benefit of a strong IT platform enables ATI to maintain an extremely high-touch management environment where clinicians and managers can be immediately responsive to patient feedback. • We are not content with small samples or biased data, so ATI invested in industry-leading methodology and was published in Advance for Physical Therapy for “What Patients Want: Innovative uses of patient satisfaction data in quality improvement and clinical management.” 10
ATI also introduced the use of the Net Promoter Score (NPS) to the physical therapy industry. The NPS is a customer loyalty metric used across many industries, including healthcare. It was introduced in Fred Reicheld’s 2003 Harvard Business Review article on the topic. Patients are asked, on a scale of 0-10, how likely they are to recommend ATI to friends and family. ATI outperforms many other well-known companies, which is a reflection of our commitment to delivering on our mission for every patient, every day. 11
Pioneering Patient Outcome Management in PT: ATI embedded a complete set of functional outcome tools directly into our EHR that are concise, easy to complete, reliable, valid, and universally recognized and respected by professionals in the field. They are immediately scored, have descriptive pop-up result information, and provide patient item responses. The findings are available to the clinician in real-time, and are aggregated for post-discharge analyses.
Enhancing Patient Clinical Outcomes While Favorably Influencing the Episodic Cost of Care for Musculoskeletal (MSK) Conditions MSKore is a proprietary tool developed by ATI to reference various descriptive analytical aspects of patient care specific to musculoskeletal (MSK) conditions Leveraging member Outcomes Report establishes a baseline of the existing care continuum and its impact on patients’ quality of life. This customizable tool facilitates the creation and implementation of care plans that enhance clinical effectiveness, reduce the cost of care, and improve the patient experience. quality satisfaction clinical scores, outcomes the and Patient MSKore®
41% of the population in this examination was male, 59% female. Most were between the ages of 50 to 59, with females exceeding males in this age group. The majority of patients fall into the normal category, followed by those considered to be overweight. • • •
Patient Demographics 12,520 12,520 42% of the population in this examination was male, 58% female. 9,116 9,116 3 % 33 % 32 % 32% Female Male Most were between the ages of 50 to 59, with females far exceeding males in this age group. The majority of patients fall into the obese category, followed by those considered to be overweight.
All Referring Physician: The number of referrals by type Referral Diversity: Percentage of total referrals by physician specialty Physical Medicine & Rehabilitation Orthopedic Family Practice Pediatric Internal Medicine Podiatrist OB/GYN 15,000 Nurse Practitioner Physician Assistant Health Care Education Physician Specialty Neurosurgeon Neurologist Orthopedic Other* 56% 56% Family Practice Internal Medicine 7% Podiatrist Physician Assistant Neurosurgeon 10,000 2% Physical Medicine and Rehabilitation 12% 12% 2% 2% 5,000 9% 9% 3% 3% Physician Demographics 0 The Majority of referrals came from Orthopedic Physicians Distant second was Family Practice and Internal Medicine Physicians
ATI Investment in Market-Specific Outpatient Therapy As XYZ-Comp may have regions in Illinois that would benefit from more outpatient treatment venues as well as improved rural outpatient coverage, this examination notes regions of Member density and potentials of partnership. Patient Distribution by Clinic 17
Physical Therapy at ATI Total Number of Patients Average Number of Comorbids Most frequently occurring comorbidity Body Part Mean PT Duration Days Neck Shoulder Elbow/Wrist/Hand Low back/Lumbar spine Hip Knee Foot 987 1919 765 2265 879 2309 1429 xxx Xxx Xxx xxx Xxx Xxx Xxx 2.6 2.2 2.2 2.8 2.6 2.2 1.8 Arthritis Arthritis Arthritis Arthritis Arthritis Arthritis Other Allergy Totals 10553 xx.x 2.3 Arthritis
General Health Measures Instrument SF-12 Subjective General Health Status ADLs and Functionality Pain/ Discomfort Mood/ Emotion/ Affect Body Part Mean Pre-tx Mean Post-tx Mean Pre-tx Mean Post-tx Mean Pre-tx Mean Post-tx Mean Pre-tx Mean Post-tx Neck 2.9 2.3 5.4 3.7 3.9 2.5 6.5 4.6 Shoulder 2.4 1.9 5.3 3.3 3.4 2.1 5.0 3.6 Elbow/ Wrist/Hand 2.2 1.8 5.4 3.5 3.1 2.1 4.9 3.7 Low back/ Lumbar spine 3.1 2.4 6.7 4.6 4.0 2.6 6.7 5.0 Hip 2.6 1.9 6.8 4.0 3.5 2.0 5.7 3.8 Knee 2.6 2.0 6.9 4.0 3.6 2.1 5.7 3.9 Foot 2.4 1.9 5.9 3.4 3.1 2.0 4.9 3.6 Total 2.6 2.0 6.1 3.8 3.5 2.2 5.6 4.0 NOTE: Lower scores indicate improvement. Red scores indicate lack of improvement. SF-12 Subjective General Health Status ADLs and Functionality Pain/ Discomfort Mood/ Emotion/ Affect Clinical Interpretation 0 = Pain Free 1 – 2 = Minimal Pain 3 – 4 = Moderate Pain 5 – 6 = Marked Pain 7 – 8 = Extreme Discomfort Clinical Interpretation 0 = No Emotional Concerns 1 – 5 = Few Emotional Concerns 6 – 10 = Mild Emotional Concerns 11 – 15 = Moderate Emotional Concerns 16 – 20 = Extreme Emotional Concerns Clinical Interpretation 0 = Excellent General Health Status 1 – 2 = Very Good General Health Status 3 – 4 = Good General Health Status 5 – 6 = Fair General Health Status 7 – 8 = Very Poor General Health Status Clinical Interpretation 0 = No Limitations 1-2 = Good Functionality 3-4 = Few Limitations 5-7 = Minimal Limitations 8-9 = Moderate Limitations 10-11 = Marked Functional Limitations 12 = Profound Functional Limitations 20
Quality and Patient Satisfaction 2016 Clinical Staff & Customer Service Clinic Facilities Professional attitude, & appearance of all staff Billing and Payment process explanation Were clearly defined goals set for your treatment? Overall comfort & appeal of clinic Clinical quality & treatment Customer Service of all Staff Were your treatment goals achieved Payer Location of clinic Patient Satisfaction RESP # XYZ ALL ATI 1696 28877 92.94% 93.68% 98.21% 98.09% 99.45% 99.10% 98.59% 98.62% 89.87% 93.12% 93.82% 94.23% 95.44% 94.50% 97.32% 96.82% 99.37% 99.30%
ATI Patient Outcomes Registry ATI’s Patient Outcomes Registry has been evaluated and accepted into the federal Agency for Healthcare Research Quality’s AHRQ) Registry of Patient Registries. This is a unique honor and distinction as no other physical therapy organization has ever accomplished this. AHRQ’s mission is to produce evidence to make healthcare safe, higher quality, more accessible, equitable, and affordable. AHRQ works within the U.S. Department of Health and Human Services with other partners to make sure that the evidence is understood and used. Our Registry was also submitted, evaluated, and accepted in U.S. National Institutes of Health’s ClinicalTrials.gov. We currently can query over 800 variables in our Registry. 24
Half of what is taught in medical school will be wrong in 10 years’ time, the problem is we don’t know which half. Sydney Burwell, MD, former Dean, Harvard Medical School
It took an average of 17 years for new knowledge generated by RCTs to be incorporated into practice. –IOM
Not a problem of too little, but too much
Just for Coronary Heart Disease… • 3600 statistical articles are published on average each year • Do you know how long it would take you to keep up…?
If you read 1 article/15 minutes You would have to read >10 articles For 2 hours/day 7 days/week Forever…
OK, So, now WHAT?
>15,000 prior-managed bills were loaded and rerun against the ODG Treatment UR Advisor for each ICD9- CPT combination on frequency, number of visits, recommendations from ODG Treatment, and the "Bill Review Payment (or ODG Approval) Flags" divided into Green, Yellow, Red…
Green, OK to auto-pay up to ODG Codes for Automated Approval max number of visits; Yellow, OK to auto-pay up to 25th%tile number of visits Red, need to review
Apple HealthKit In 14 of 23 major hospitals are trialing (Google and Samsung discussing health-based technology plans) Healthcare + fitness apps = comprehensive picture Send to MD or case manager
And, it’s not just Kinect for rehab… …yes, you guessed it, there is also…
