Successful patient care historically has been measured either with
positive patient satisfaction scores or through increased revenue or profit.
With the movement toward proper documentation in patient care, third party
payers and referral sources want to see more proof of the intended results.
Although the treatment protocols O&P practitioners currently follow
— for everything from treating specific conditions or deciding on
components — come from years of experience or have been passed down by
senior clinicians, that does not necessarily mean they are the right methods of
care, Jim Alaimo, CPO, consultant at Alaimo Healthcare Solutions, said.
“The questions we should be asking are, ‘Does this procedure
really work? Where is the scientific data to support our treatment methods? Are
we achieving the best possible results?’” Alaimo said. “Only
evidenced-based or patient-reported data provides the necessary information to
make the most optimum decision.”
To lay the groundwork for establishing practical O&P outcomes,
O&P business owners first must develop a plan, he told O&P
Business News. A solid plan of action involves educating all
practitioners and office staff members about the purpose of the outcomes study,
which patient types are involved, how to administer the study to the patients
and how the results will be used. Next, they should set reasonable objectives
for both practitioners and patients. Alaimo described that business owners
should decide which items require further study and then determine which
procedures or policies need improvement.
“There are certain criteria or benchmarks that should be followed
when developing an outcomes program,” he said.
First, the outcomes should be reliable. Patient questionnaires should
offer clear wording and should provide consistent results across the patient
population. The outcomes also must prove to be valid and measure the
differences in performance that they set out to measure. Finally, the results
should measure the patients’ responsiveness to the treatment, and changes
should be recorded as improvement or worsening of the patient’s functional
abilities or confidence levels.
Results of the outcomes study then can be communicated to those involved
in the patient’s care — physicians and other referral sources,
patient case workers and third party payers — depending on individual
necessity. These can be broadly distributed as informational through published
articles, newsletters and in-services, or presented as patient-specific details
through letters or e-mails.
Referral sources typically want to know how well their patients have
adjusted to wearing their new prostheses or the level of functional improvement
they have had with their prescribed orthotic devices. Third party payers, on
the other hand, use this information to determine whether patients are weaning
themselves from assistance devices and becoming more independent, Alaimo said.
The results can also be compared to a national study using such tests as
the Activities-specific Balance Confidence Scale.
“There’s not a better way to differentiate yourself from
others if done professionally,” Alaimo said.
He offered the following small steps for business owners to get started:
- Develop a 20- to 30-question study, set a short time frame to
collect the date, use Survey Monkey or other data collection software;
- Inform staff members of the plan and why it is important;
- Collect data the same way every time, no exceptions;
- Create a release form for patients to sign;
- Review the data on a regular basis; and
- Convert the data to spreadsheets and design charts or graphs, using
the data to tell a nonfiction story.
“I believe our patients and referral sources appreciate clinicians
that take the time to conduct outcome studies. I’d like to think it gives
us an edge in professionalism that our industry is striving for,” he said.
“How many times have we had insurance companies state that the component
we want to put on a patient is experimental? Outcomes take the
‘experimental’ out of the equation by providing documented
This commitment provides a significant reward at the end of the process,
he said. — by Stephanie Z. Pavlou
Disclosure: Jim Alaimo, CPO, has no
direct financial interest in any products or companies mentioned in this
The question of outcomes has been raised for many years and rightfully
Mr. Alaimo makes a strong case for measuring organizational performance
and explains a process for starting your own outcomes measures. I am a member
of the National Quality Forum and am the chair of the Knowledge Taskforce of
the ASAE Healthcare Committee. There is no doubt in my mind that specific
performance objectives will need to be met and demonstrated to be eligible for
full reimbursement in the not-too-distant future. The collection of data by
individual organizations can provide total organizational information about lab
operations, staff performance and the care it provides to its patients, but
without uniform tools used by multiple organizations to collect data, the
information obtained cannot be readily used to support the O&P profession.
As a practitioner, you know the quality and the value of the services
you provide. We need to communicate that value and to elevate the stature of
the O&P profession among payers. The only sure way to do that in
today’s environment is with data. Each practitioner and each practice
should support the profession by uniformly documenting their outcomes. The
practice can learn valuable information about itself and make improvements, the
patients benefit through the increased knowledge their clinicians obtain and
the profession benefits by having a broad-based set of data that demonstrates
specific clinical interventions and the results thereof. Just as you enable
your patients to achieve their goals, there are organizations that can help you
achieve your performance management goals.
— Scott Williamson, CAE
Disclosure: Scott Williamson, CAE, has no financial or other
conflicts of interest regarding this article