Researchers win grant to evaluate innovative “Physical Therapy First” program for orthopaedic care
The SC SmartState Center for Effectiveness Research in Orthopaedics (CERortho) has been awarded a $100,000 grant from the Foundation for Physical Therapy to advance program that has already shown promise in lowering costs and improving outcomes for patients with musculoskeletal issues. The project is led by Chuck Thigpen, director of Observational Research in Orthopaedics for CERortho and a research scientist with ATI Physical Therapy. Team members include CERortho SmartState Endowed Chair John Brooks, assistant professors Melanie Cozad and Cole Chapman, and doctoral student Adam Lutz.
Ranked third among healthcare burdens in the United States, musculoskeletal care is estimated to affect 54 percent of the population, accounting for nearly one in five healthcare visits. Musculoskeletal care exceeds $176 billion in direct healthcare costs and $876 billion in indirect costs annually.
“These costs have continued to rise with no real improvement in patient outcomes potentially due to fragmented, traditional U.S. healthcare models, which tend to use early advanced imaging and multi-modal pharmaceutical prescriptions, despite evidence for marginal outcomes, increased cost, and increased surgical rates specifically with early MRI,” says Thigpen. “Neck, Back, shoulder, hip, and knee pain account for over 80 percent of these diagnoses, with a majority responding to physical therapy, making physical therapists uniquely qualified to spearhead musculoskeletal care with the potential to improve patient outcomes while limiting unneeded medical care.”
This model has been implemented in military and nationalized health systems, resulting in lower healthcare costs and positive patient outcomes. However, there is limited evidence of the effectiveness of a physical-therapy led approach for musculoskeletal patients in the U.S. private arena.
In 2012, Greenville Health System partnered with ATI Physical Therapy and Blue Cross Blue Shield of South Carolina to establish the Back and Neck Program (expanded to include shoulder and knee pain in 2016 and hip pain in 2017) as a pilot study to test this “physical therapy first” model in the private sector. Recent publication of the early results show $1,543 per patient , nearly 50 percent less than those who began their care with a physician referral. These savings increase compared to those who did not enroll in the program. The initial program also yielded high patient satisfaction, significant improvement of outcomes from start of care to discharge, including lower pharmacy, imaging, and physician visit costs.
Since its inception, the program has grown from four clinics and 15 physical therapists to 16 clinics and 150 physical therapists and has been renamed (Musculoskeletal (MSK) Program) to reflect the variety of issues it has expanded to address. The MSK program provides an appointment with a physical therapist within 47 hours at one of 16 ATI Therapy locations throughout the Greenville region for GHS employees and beneficiaries without referral (though referrals are also permitted) with only a $20 co-payment.
Thigpen and his team will use the Magistro Family Foundation Research Grant from the Physical Therapy Foundation to conduct a comprehensive evaluation of the program over a two-year period. Collaborating with the same partners, as well as Steadman Hawkins Clinics of the Carolinas, the researchers will collect a variety of data, comparing musculoskeletal patients who have enrolled in the program to those who use alternate approaches to resolving their musculoskeletal complaints.
“We believe this study will provide payers, employers and other key stakeholders with important results to guide the evolution of this model,” says Thigpen. “Additionally, insights gained through this study will influence these new models and provide evidence to implement a scalable, best practice model the private arena.”
FOR IMMEDIATE RELEASE
July 17, 2019
APTA: Emilio J. Rouco 703-706-3393 Schmidt Public Affairs: Ellen Almond 703.548.1163
Physical Therapy Groups Release Roadmap to Create Benchmarks for High-Quality, Value-Based Care
New report designed to help improve patients’ quality of care and establish baseline metrics for determining the value of physical therapy
Alexandria, VA –– Today a group of physical therapy stakeholders – making up the Physical Therapy Industry (PTI) Outcome Workgroup – released a new report that establishes benchmarks of quality care in the field of physical therapy. As the first report of its kind, the results provide physical therapists (PTs) with key insights into the delivery of high-value care while also helping policymakers and payers better determine the value of PT services provided to millions of Americans every year.
To minimize variation and improve the quality of care provided to consumers, health plans, and employers, the work group evaluated how clinical outcomes could be used by the physical therapy community to enhance the value of care. More specifically, the report shows how benchmarking can improve value-based payment and outcomes reporting for providers and the broader health care industry. “By engaging in this collaborative effort with physical therapy stakeholders representing all 50 states, our community has reached a major milestone in advancing high-quality care and value for our patients,” said Bridget Morehouse, senior vice president of contracts and pricing at ATI Physical Therapy and spokeswoman for the work group. “To advance these goals, the PT community is proud to develop the new quality care benchmarks that will help underscore the tremendous value of physical therapy in helping Americans recover from injuries and illness, manage their pain, and regain their independence.”
The report released today produced the largest multipractice analysis of open-source, risk-adjusted clinical outcomes in the outpatient physical therapy industry. After carefully analyzing data that covers 375,000 patient episodes in all 50 states, the work group established national clinical outcomes benchmarks across the three most common areas in outpatient orthopedics (spine, shoulder, and knee care, which represent approximately 80% of orthopedic care), while using a risk-adjustment and stratification approach approved by the Centers for Medicare & Medicaid Services (CMS) and adopted from the orthopedic community.
Other key findings include:
- Clinically important improvements in patient-reported outcomes (PRO) were observed across
body regions over 12-14 visits.
- Baseline patient factors for all data contributors explain a large portion of variation in PRO change within episodes. Payer type, patient socio-demographic factors, and comorbidities at baseline all had strong effects on PRO changes over episodes of care. Differences in these baseline patient factors must be accounted for to ensure fair performance comparisons of physical therapists.
- When reporting clinical outcomes as a measure of quality of care for outpatient physical therapy, risk adjustment should be considered and include factors such as BMI, patient age, comorbidities, smoking status, chronicity, pain, zip code of residency, and payer type; these factors influence the patient outcome and the utilization of physical therapist services.
“This report further supports the importance of PRO in clinical practice to evaluate the outcomes of our patients, and highlights the need for standardized data collection by physical therapists to include key patient characteristics that can be used to risk adjust these measures,” said Heather Smith, PT, MPH, APTA public affairs director of quality.
“The benchmarks established in this report show that physical therapy adds incredible value to both patient care and the broader health care system,” said Nikesh Patel, PT, executive director of APTQI. “Based on the outcomes of this analysis, we urge payers to reflect the value of physical therapy in future insurance design and reduce barriers to PT treatment.”
The volunteer work group of industry stakeholders was formed in August 2015 to create a collective voice for the physical therapy profession to evaluate how clinical outcomes could be used to improve quality of care, minimize variation, and establish value-based payment and outcomes reporting for consumers, health plans, employers, and the health care industry. The work group consisted of industry stakeholders from the American Physical Therapy Association, Alliance for Physical Therapy Quality and Innovation, WebPT, Select Medical, BMS Practice Solutions, Intermountain Health Care, PT Northwest, ATI Physical Therapy, and US Physical Therapy. The group evaluated the ability of PRO as performance measures and created national benchmarks, where possible, for use in outpatient physical therapist practice.
The group contracted with the Center for Effectiveness Research in Orthopaedics to develop risk- adjusted performance measure algorithms for physical therapists using legacy patient-reported outcome measures and patient-level information. The report, titled “Evaluation of Legacy Patient- Reported Outcome Measures as Performance Measures in Rehabilitation,” can be read in its entirety HERE.
About the groups
The Alliance for Physical Therapy Quality and Innovation (APTQI) unites community-based physical therapy practices to advocate for the profession in the areas of payment reform, quality initiatives, patient outcomes, and innovation. To learn more, visit www.aptqi.com. The American Physical Therapy Association (APTA) represents more than 100,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. VisitMoveForwardPT.com to learn more about the types of conditions physical therapists treat, and find a physical therapist in your area. To learn more, visit