5. 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!
6. I was always frustrated with the
disconnect of collecting PROs in real-
time for the clinician (as well as me!)
10. 10
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.”
11. 11
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.
12. 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.
13. Leveraging quality clinical outcomes and
member satisfaction scores, the Patient
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.
MSKore is a proprietary tool developed by ATI to reference various descriptive
analytical aspects of patient care specific to musculoskeletal (MSK) conditions
Enhancing Patient Clinical Outcomes While
Favorably Influencing the Episodic Cost of Care
for Musculoskeletal (MSK) Conditions
MSKore®
14. • 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.
15. 12,520
9,116
Female Male
42% of the population in this examination was
male, 58% female.
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.
3
%
32% 32
%
33
%
Patient Demographics
16. Referral Diversity: Percentage of total
referrals by physician specialty
Physician Specialty
Orthopedic
Family Practice
Internal Medicine
Podiatrist
Physician
Assistant
Neurosurgeon
Physical Medicine
and Rehabilitation
56%
12%
7%
2%
3%9%
2%
Physician Demographics
The Majority of referrals came from Orthopedic Physicians
Distant second was Family Practice and Internal Medicine Physicians
15,000
5,000
0
10,000
Orthopedic
Family Practice
Internal Medicine
Physician Assistant
Podiatrist
Neurosurgeon
Pediatric
Physical Medicine
& Rehabilitation
OB/GYN
Health Care Education
Nurse Practitioner
Other*
Neurologist
All Referring Physician: The number of
referrals by type
17. 17
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
ATI Investment in
Market-Specific
Outpatient Therapy
18. Physical Therapy at ATI
Body Part
Total Number of
Patients
Mean PT Duration Days
Average Number of
Comorbids
Most frequently occurring
comorbidity
Neck 987 xxx 2.6 Arthritis
Shoulder 1919 Xxx 2.2 Arthritis
Elbow/Wrist/Hand 765 Xxx 2.2 Arthritis
Low back/Lumbar spine 2265 xxx 2.8 Arthritis
Hip 879 Xxx 2.6 Arthritis
Knee 2309 Xxx 2.2 Arthritis
Foot 1429 Xxx 1.8 Other Allergy
Totals 10553 xx.x 2.3 Arthritis
20. 20
General Health Measures
Instrument SF-12
Body Part
Subjective General Health Status ADLs and Functionality Pain/ Discomfort Mood/ Emotion/ Affect
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 = 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
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
21. Payer
2016 Clinical Staff & Customer Service Clinic Facilities
RESP #
Patient
Satisfaction
Clinical
quality &
treatment
Professional
attitude, &
appearance of
all staff
Customer
Service of all
Staff
Billing and
Payment
process
explanation
Were clearly
defined goals
set for your
treatment?
Were your
treatment
goals achieved
Overall
comfort &
appeal of
clinic
Location
of clinic
XYZ 1696 92.94% 98.21% 99.45% 98.59% 89.87% 93.82% 95.44% 97.32% 99.37%
ALL ATI 28877 93.68% 98.09% 99.10% 98.62% 93.12% 94.23% 94.50% 96.82% 99.30%
Quality and Patient Satisfaction
24. 24
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.
31. 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
32. It took an average
of 17 years for
new knowledge
generated by
RCTs to be
incorporated into
practice.
–IOM
36. • 3600 statistical articles are published
on average each year
• Do you know how long it would
take you to keep up…?
Just for Coronary Heart Disease…
37.
38. If you read 1 article/15 minutes
You would have to read >10
articles
For 2 hours/day
7 days/week
Forever…
43. >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…
44. 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
45.
46. 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
47.
48.
49.
50. …yes, you guessed it, there is also…
And, it’s not just Kinect for rehab…
51.
52. Evidence-Based Medicine Precision Medicine
Model General Specific
Sample Large cohorts “N of 1” but a massive
number of data-
points/inputs
Decisions Infer recommendations
applied to all thus “one size
fits all”
Limited to no
generalizability
Outliers Ignored None
Statistical Power Good Poor
53. Can be viewed as mutually complementary.
Merging the strengths of both will be based on our capacity to
perform deep investigations of large cohorts of patients.
The conversion from single cases to an evidence-based
approach will imply collation and meta-analyses of big data
from cross-institutional and transnational large-scale registers
and cohorts.
“N-of-one” cases to an “N-of many” paradigm.
Reconciling evidence-based medicine
and precision medicine*
54. This transition to an “evidence-based precision medicine” will,
however, necessitate standardization as well as responsible
sharing and mutualizing across numerous interoperable data
warehouses.
Following the same rationale, the numerous registries and
large biobanks that are assembled all over the world should
also be constructed in such a way as to warrant this need for
inter-operability.
* Beckmann, JS & Lew, D. (2016). Reconciling evidence-based medicine and precision medicine in the era of big data: challenges and opportunities, Genome
Medicine20168:134. DOI: 10.1186/s13073-016-0388-7
Reconciling evidence-based medicine
and precision medicine*
55.
56. We are in the midst of some
wonderfully revolutionalry and
promising changes afoot…
57.
58.
59. Please be in touch
Chris.Stout@ATIPT.com
or visit DrChrisStout.com for these
slides and references
60. All disclosures up to date on AAOS
None relevant to this topic
Disclosures
