WHITE PAPER Patient Engagement in Physical Therapy How PT practices can drive better outcomes, increase revenue, and rediscover their passion for the

Transcription

1 WHITE PAPER Patient Engagement in Physical Therapy How PT practices can drive better outcomes, increase revenue, and rediscover their passion for the profession by focusing on improved patient engagement.

2 Contents INTRODUCTION... 3 PATIENT ENGAGEMENT AND VALUE-BASED CARE... 4 PATIENT ENGAGEMENT AND FEE-FOR-SERVICE... 6 OPTIMIZING PATIENT ENGAGEMENT AT YOUR PRACTICE... 7 Assessing Your Practice... 7 Leveraging Technology to Support Patient Engagement... 9 CONCLUSION Clinicient Inc. All rights reserved. 2

3 Introduction Most physical therapists join the profession because they want to make a difference in people s lives. The challenge, for many of these PTs, is to find a way to remain focused on that goal as they juggle the demands of their chosen career. Physical therapists, along with other health professionals, have faced enormous pressure in recent years to devote more and more time to documentation and billing. The problem is rooted in the financial incentives: Fee-for-service payment models reward quantity of care provided, not care quality or patient outcomes; and wind up burying therapists in endless administrative tasks as they deal with insurers and their required paperwork. Caught in the constant hustle to file claims and boost revenue, it can be easy for therapists to lose sight of their ideals. Some eventually stop doing only what s best for patients, and instead pile on services that mostly benefit their practice. The good news is, this is all about to change and in many parts of the country, it s changing already. The federal government, through the Centers for Medicare and Medicaid Services (CMS), is pushing the industry away from fee-for-service and toward new reimbursement contracts rewarding high-quality care. Providers are now participating in value-based alternative payment models, including the Comprehensive Joint Replacement Model (CJR) and the Bundled Payments for Care Improvement initiative (BPCI). These up-andcoming programs, and numerous others like them, incentivize providers for achieving better outcomes, and doing so in ways that rein in costs. And most important, when it comes to physical therapy, these new payment models encourage patient-centered care. Their purpose is in line with why PTs practice in the first place: to help people get better faster despite the obstacles in their way. What follows is a report on what many PTs believe will be key to success in this value-based world: patient engagement across the continuum of care. It will show how practices that make patient engagement a priority that give their therapists the tools they need to partner with patients effectively can drive better outcomes and increase revenue. And finally, it will make the case that a strong patient engagement strategy is not merely good for a practice s bottom line. Better partnerships with patients can improve the physical therapy profession, and it s good for the hearts and minds of physical therapists themselves. As budding PT students, our main thought is always meaningful work helping people recover, helping patients move better. In the trenches of the clinic though, our reality is much different than the ideal we envisioned in school. High patient volumes, minimal time for one on one care, and outdated processes lead to therapist burnout. Patient engagement is about humanizing recovery again. It s about connecting patients and providers in meaningful ways. David Self, DPT Co-Founder and Chief Strategy Officer, Keet Health 2018 Clinicient Inc. All rights reserved. 3

4 PATIENT ENGAGEMENT AND VALUE-BASED CARE The first pillar of the Institute for Healthcare Improvement s Triple Aim, a list of goals seen as critical to high-value healthcare, involves improving the patient experience of care. In order to optimize health system performance, the IHI notes, providers must put patients and their families at the heart of every decision, and empower them to be genuine partners in their care. 1 Heralding a new era of patient and family engagement, the IHI implores health systems to bolster the patient experience by strengthening care coordination among collaborating providers, and by improving provider-patient communication. Healthcare organizations, and the professionals within them, should welcome the patient s voice and influence and involve them (and their families) in the decisions around their care. The Triple Aim, first articulated in 2008, later helped to shape the language in the Affordable Care Act, and is now part and parcel to value-based care. 2 In late 2016, for example, CMS announced the launch of its Person and Family Engagement Strategy, an initiative the agency calls key to achieving better outcomes. 3 In a letter explaining the purpose of the program, the director of the agency s Center for Clinical Standards and Quality, Kate Goodrich, MD, MHS, writes that person and family engagement involves patients and their families being part of the health care team by working collaboratively with their doctor or other health care professional to be active partners when making decisions about their health. Such engagement is important, Goodrich continues, because it results in a better patient experience, as well as better care. When people feel responsible for their own health and are partners with their providers in goal-setting and decision-making, they are much more likely to achieve their health care goals. These person- and family-engagement values are intended to guide policies and programs across the healthcare industry, and are now among the driving forces behind CMS s Quality Payment Program (QPP), which rewards clinicians for providing high-quality care. 4 Included in the six goals outlined in the CMS Quality Strategy, which Most of our current systems and processes, including patient intake, clinical documentation, charge capture, and billing and claims processing, are done to serve the thirdparty payer. Patient engagement moves us away from those processes that only benefit payers, and toward those that serve our actual customer, the patient. Jerry Henderson, PT Vice President of Clinical Strategy Clinicient 1 See: 2 See: 3 See: 4 See: Instruments/QualityInitiativesGenInfo/Downloads/Person-and-Family-Engagement-Strategy-Summary.pdf 2018 Clinicient Inc. All rights reserved. 4

5 serves as the backbone for the QPP: Strengthen persons and their families as partners in their care. 5 In the latest version of this strategy (it s revised annually in a report to Congress), CMS is trying to create a healthcare system that fully engages individuals and families in the design, delivery, and evaluation of care. Citing studies of person-centered care models that improve quality of care and health outcomes, engage people more actively in their health care, and can reduce costs and disparities in care, the agency goes on to list objectives healthcare organizations should target in pursuit of these goals: Ensure all care delivery incorporates person and family preferences (treat patients as partners; consider personal values and goals; put the patient at the center of care) Improve experience of care for persons and families (use evidence-based services across the continuum of care; expand patient education; build community-clinical partnerships) Promote self-management (provide patients access to information they can use to better manage their conditions on their own) Recent studies indicate that most states are now investing in valuebased reimbursement models, and private payers are embracing such models, as well. Looking ahead, as value-based care becomes the norm, it s clear that providers who excel at patient engagement will be best positioned for success. This is true for clinicians in all specialties, but it s especially the case for physical therapists. PTs who collaborate with hospitals and ACOs, for example, will need to leverage patient engagement to reduce readmissions and earn incentives through bundled-payment programs like CJR and BPCI. Getting patients involved in their own care, in other words, will lead to better outcomes at lower costs. 6 Those are objectives that have always been worth striving for, but in value-based care, they re going to be essential and they may eventually determine which practices stay in business. Patient engagement will be absolutely essential in the valuebased-care environment. For PTs, and for any provider, the challenge in the future will be to meet the patient where they re at in their continuum of care. If someone is highly motivated, it will be OK to see them less you can give them digital tools they can use to drive their own care. And then you can devote more to those patients who need the extra help. Jon Read President and CEO Keet Health 5 See: Quality-Strategy.pdf 6 See: Clinicient Inc. All rights reserved. 5

6 PATIENT ENGAGEMENT AND FEE-FOR-SERVICE While the need for patient engagement will certainly grow in the future, most therapists would agree it s also important right now. In today s typical fee-for-service environment, people are paying more and more out of pocket for treatments and services previously covered by insurers. As these patients take on more responsibility for the costs of care, they re increasingly acting more like consumers, shopping around for care they deem affordable and avoiding those providers they decide are too expensive. One recent survey by the Kaiser Family Foundation found that the average insurance deductible under employer-sponsored health plans went up 49 percent between 2011 and More than 50 percent of workers now have a deductible greater than $1,000, the survey found. Such high out-of-pocket costs have led many patients to think twice about purchasing certain healthcare services, and to be more demanding of the providers they choose to see. For physical therapists, this means it s important not only to provide high-quality care, but to design the care experience around what patients want. That begins in the office at the front desk, in the way one is greeted when they check-in for an appointment and in the paperwork they re asked to fill out while they wait; and it continues throughout a patient s time in the clinic, from the moment they meet their PT for the first time to the day that they re told their rehabilitation is complete. And finally, the care experience goes beyond the walls of the practice and incorporates interactions that take place remotely. Patients, as consumers, expect that their healthcare will reflect their modern world: If they can bank online, or make purchases over , and they can learn about anything by watching videos on their phone, why not ask therapists to offer these capabilities as well? Ultimately, what these patients want in addition to high-quality, affordable care is convenience and easy access, whether it s while they re in the clinic or after they leave. Therapists who excel at providing these things will earn patients trust and loyalty, and will benefit when these patients recommend their services to their friends and family. In that way patient engagement is not only a tool for valuebased care, but a way to increase revenue today. 79% One survey found that 79 percent of patients prefer providers who permit interactions online, via mobile device, or through a self-service kiosk. Another found that 90 percent of patients conduct research on providers before booking their appointments. Source: Putting Patients in Control, quadramed.com. Patient Access Journey, kyruus.com. 7 See: to in-2016-more-workers-enroll-in-high-deductible-plans-with-savings-option-over-past-twoyears/?utm_campaign=kff-2016-september-ehbs&utm_content= &utm_medium=social&utm_source=twitter 2018 Clinicient Inc. All rights reserved. 6

7 OPTIMIZING PATIENT ENGAGEMENT AT YOUR PRACTICE Accepting that patient engagement is important is one thing, but what does it actually look like in practice? Physical therapists are already stretched thin just keeping up with their patients and paperwork. How are they supposed to ramp up patient engagement when they feel like they don t have a minute to spare? The answer begins with an assessment of one s practice and any patient-engagement efforts already underway. After that, it s a matter of deciding how far to go and adopting the various tools you re going to need to get there. ASSESSING YOUR PRACTICE If you have the sense that patient engagement is lacking at your practice, it may be tempting to just throw technology at the problem and hope that it brings everything up to speed. That would be a major mistake like buying a Ferrari because your drive to work takes too long. Instead, take a step back, talk to your colleagues, and look closely at the systems you already have in place. And try to put yourself in your patients shoes: What does their experience look like from the very first interaction they have with your clinic to their last appointment with their therapist and beyond? On the following page are some other questions to ask: There s a marketing component to patient engagement as well. Think about it: If you go into a bank today, you expect them to offer online and mobile banking you expect access to that bank from wherever you are. And if they don t offer it, you re going somewhere else. It s becoming no different in healthcare now. Patients want personalized, accessible, and mobile care. If you can offer that to them, that s a brand asset; it s going to be good for business. David Self, DPT Co-Founder and Chief Strategy Officer, Keet Health 2018 Clinicient Inc. All rights reserved. 7

8 How do would-be patients find your practice? Do you have a website, Facebook page, or other social media presence (and more importantly, do you update each regularly with new content that accurately reflects what your practice is all about)? If you do, you re obviously trying to connect with potential clients, but the bigger question is whether you re getting their response. True engagement, after all, must include a back-and-forth if you send a message out, but no one is listening, the only one who is engaged is yourself. What happens when a new or existing patient calls your practice? If someone calls in to make an appointment, how do front-desk staff answer the phone? Do staff know what to do when a patient asks to speak to their therapist, but that PT is busy with another patient? What information do you collect over the phone, and what do you usually collect once they come in? First impressions are everything, so it s important that you have a consistent and positive process in place. What happens when a patient comes in for an appointment? How do staff greet patients at the front desk or do therapists themselves meet patients at the door? Do front-office staff hand patients a stack of paperwork to complete while they wait, or are they brought out to the therapist s space immediately? Are there magazines or other reading materials in the waiting area (or games for children in the case of the pediatric clinic)? Think about what it s like to walk into your practice for the first time: What is that experience like and how does it unfold? How do PTs interact with their patients? Again, start at the beginning, when the therapist greets the patient. What do they say? Are they friendly and easy-going, and ready for a conversation, or are they clearly under pressure to maintain a tight schedule? Consider how the therapist works: How do they take their notes, and how much time do they spend looking at their computer or phone relative to the time they keep their focus on the patient? When a patient leaves, what do they take with them? Presumably the patient has a home exercise program, but what do you do to ensure that they follow it given their personal circumstances? And when patients need to return to your practice, how do you decide how often they should do so? Are you going to ask a hard-charging executive who travels a lot to come back twice a week for the next two months? And what about the elderly patient who may have trouble getting to your clinic in the first place? How do you remarket to your patients? When a patient is done with their treatment at your clinic, what happens then? Do you check in with them every so often so they keep you in mind for any future needs (and so they remember to refer you to their colleagues and friends)? Do you send them information that encourages them to look at physical therapy as more than just a way to recover from an injury? Practices that do an effective job of remarketing may see patients return for maintenance or preventive care as they get ready for their first marathon or an active vacation. Or maybe they ll schedule prehab visits to ensure they re as strong as possible prior to a scheduled surgery Clinicient Inc. All rights reserved. 8

9 LEVERAGING TECHNOLOGY TO SUPPORT PATIENT ENGAGEMENT If marketing, remarketing, and ongoing patient outreach sound like a lot of work that most therapists don t have time to do, that s because it s true: The typical PT is too busy for this level of engagement, let alone the demands of everyday patient care. Fortunately, most practices can afford to make minor changes to their workflows to encourage better communication between administrators, therapists, and the patients they see. And they can invest the minimal time and energy required to ensure that their online platforms are up to speed. Beyond that, however, many practices hit a wall: How can they improve patient engagement outside of the clinic in ways that will help them to achieve better outcomes? The solution is to use technology to do the job. Employ technology built into the EMR An electronic medical record system that has built-in patient-engagement functions can take notes entered by the physical therapist and automatically create messaging tailored to the patient. A patient who wants to start their home exercise program can access this messaging through an app or online patient portal. Once she logs in, she ll find clinical tasks and educational materials she can refer to at any time. The technology permits secure back-and-forth communication, so if there are any questions about how an exercise should be completed, they can be addressed by the therapist as necessary. Badges and other digital prizes can be awarded when certain milestones are met, and surveys can be used to collect patient-reported outcomes throughout the rehabilitation process. Employ technology to improve marketing and patient-retention capabilities Patient-outreach technologies can also be used for marketing, appointment reminders, and other purposes. Automated s, text messaging, and customer-experience survey tools are all effective ways to communicate with current and future clients wherever they are in relation to your practice. A message might be sent prior to an appointment, for example, not only to remind the patient to show up, but to encourage her to provide insurance information in advance. The message might also include information about what the patient should expect and an easy way for her to reply if she has any questions Clinicient Inc. All rights reserved. 9

10 Conclusion In the end, effective patient engagement requires a variety of communication channels: face-to-face conversations between therapists and their clients, online platforms like and social media, and technologies integrated with the EMR. It involves practices pushing information out to their clients to help them with their exercise programs outside of the clinic. And it involves patients pushing information back, via phone, surveys, or through secure messaging. Practices that improve patient engagement will find that engaged patients are happier clients who come back again and recommend them to their friends. They ll also find that they re easier to work with, achieve better results, and have lower costs associated with their care. And finally, practices will see that better patient engagement is what their therapists really want. It s a way for them to become better at their profession and to rediscover their passion for patient care. ABOUT CLINICIENT Clinicient helps outpatient rehabilitation therapy businesses optimize their clinical and financial operations from patient to payment, through a combination of patient-centric, measurable, outcomes-driven software and best practices services. By combining the clinical tools that allow our clients to efficiently deliver and document care, with the financial tools to maximize their reimbursement all in a single system, we enable our clients to provide more great care, improve more lives and thrive through payment reform. For more information on how Clinicient can help your organization build stronger relationships with your patients call (877) or visit ABOUT KEET HEALTH Founded in 2015 in Austin, Texas, Keet Health is reimagining recovery. Designed to keep patients connected to their care, Keet helps clinicians offer unparalleled patient experiences without adding more work for clinic staff. Through digital care plans, relevant patient education, secure messaging, and personalized patient communication, Keet empowers clinics to engage patients in meaningful ways. For more information call (512) or visit Follow Keet on 2018 Clinicient Inc. All rights reserved. 10