Clinical Outcomes Part 3: Patient-Reported Outcome Measures (PROMs) in Therapy

31 May 2016

It is becoming increasingly rare to pick up a journal or participate in an alternative payment model webinar that doesn’t mention Patient-Reported Outcome Measures (PROMs) as a key element in the transition toward outcome-based reimbursement.  While the PROM acronym may be relatively new to therapy providers, the practice of using patient-reported measures to help quantify patient progression has been on the rise for some time now.

For some therapists, the use of PROMs has been part of their clinical practice for years.  However, the use of standardized assessment tools didn’t become commonplace for many clinicians until CMS’s implementation of Functional Limitation Reporting in 2013 as therapists began to use tools such as the Lower Extremity Functional Scale, QuickDASH, and Oswestry to help assign severity modifiers to the functional limitation G-codes.  As a result, most physical and occupational therapists have a degree of familiarity with various patient-reported assessment tools, but they may not be incorporating these measures across the board with all of their patients.  Establishing a standard process for capturing clinical outcome data for patients from ALL payers will be helpful in the coming years as payment models shift to incorporate measureable clinical outcomes.

Why Patient-Reported Outcome Measures?

There are a multitude of clinical assessment tools available, most of which can be readily found online.  These range from simple questionnaires consisting of a handful of questions to much more complex instruments which can require measurement and analysis on the part of the clinician.  Key factors to consider when selecting assessment tools to use in your practice are ease of use and clinical relevance.  I tend to favor patient-reported outcome measures (e.g. Oswestry, QuickDASH, etc.) as opposed to performance tools which require objective measurements or observations on the part of the therapist (e.g. Berg, Tinetti, etc.).  For one, the patient-reported outcome measures require less time to administer on the part of the clinician.  Secondly, PROMs give patients the ability to report, in my opinion, the most important outcome measure, which is the patients’ perception of their functional status, their overall well-being, and their response to the therapeutic interventions they have received.  The quantification of the patients’ perception of their functional improvement can be beneficial in clinical decision making and in providing insight into the benefits of various treatment strategies from the start of therapy to discharge.  Furthermore, PROMs can facilitate improved communication among patients, providers, and insurance carriers especially if clinicians are utilizing tools that are common in the industry.

Selecting Outcome Measures

When I first started selecting outcome measures to utilize in my practice, I looked for tools which were supported in the literature, widely recognized in the industry among clinicians and payers, and presented as little administrative burden as possible.  I also wanted tools that weren’t especially lengthy so that patients didn’t become exasperated when trying to complete them.  (Over the years, I have even encountered some practices that have designed their own assessment tools for measuring clinical outcomes.  However, these typically lose relevance outside the facility.)

Examples of commonly used PROMs include the QuickDASH, the Modified Lumbar Oswestry, the Neck Disability Index, the Lower Extremity Functional Scale, and the Shoulder Pain and Disability Index.  The validity of these tools has been supported in peer-reviewed journals, and these are measures that are familiar to therapy providers, physicians, and payers.  We do use various other PROMs in our practices; however, we try to limit the number of tools so as not to dilute the cumulative data over multiple instruments.

As you investigate which outcome measures to use in your practice, it may also be worthwhile to reach out to referral sources and payers to inquire if they have a preferred tool or instrument they like to reference when it comes to quantifying patient progress and perception of improvement.  This can be a valuable conversation to have in establishing relationships with physicians and payers alike.  Also, the ability to capture and share outcome data can be a great asset in aligning your practice with other providers in the healthcare continuum, such as accountable care organizations (ACOs) and hospitals participating in bundled payment initiatives such as BPCI and CJR.  Selecting outcome measures which are being utilized by these entities can help position your clinic as a preferred provider for outpatient therapy.

We have outcome data.  Now what?

Capturing outcome data is only the first step.  The key is knowing what to do with the data once you have it.  Within our company, the regular review of outcome data is an integral part of our overall management approach.  We use our outcome data to evaluate the effectiveness of our treatment programs and even individual clinicians.  The data also serves as a point of communication for referring physicians and among clinicians.

While comparing clinical outcomes to other practices or national benchmarks can be difficult due to the lack of shared outcome data, we do compare our results to the minimum clinically important difference (MCID) for the various tools.  The MCID represents the smallest amount of change the patient perceives to be important from the start of care to discharge.  However, this too can prove to be challenging, as these values often vary in the literature.  Having an idea, though, of the range of MCID values for various tools can give clinicians a benchmark to which they can compare their clinical outcome data.

Outcomes ARE the future

As healthcare continues to move toward outcome-based reimbursement and pay-for-performance models, clinical outcome data will play an increasingly larger role in providers’ day-to-day practice.  If you have yet to incorporate outcome reporting in your practice or are unsure how best to utilize the clinical outcome data you are currently capturing, ask us how we can help.  Visit us online at www.irg.net or contact us at requestinfo@irg.net.


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