"Data from the profession, for the profession, to help elevate patient care." That's the description of a new online registry that could become a source of evidence-based medicine (EBM) specific to the physical therapy (PT) industry.
The American Physical Therapy Association recently launched its Physical Therapy Outcomes Registry as a way to better understand the industry's practice patterns and outcomes. Workers' compensation practitioners hope it leads to a better understanding of the most optimal treatments for injured workers.
"EBM is often no more than the qualified, nonbiased study of data and outcomes along with summaries and recommendations that meet industry standards," said Kenneth Eichler, vice president of regulatory and outcomeutcome Initiatives for the Work Loss Data Institute/ODG, a division of MCG & Hearst Health. "It may be a real database for studies."
The registry
The registry will collect and aggregate electronic health record data from participating physical therapists and practices. It will provide a "real-time source of comprehensive physical therapy data," to help make better clinical decisions and track and benchmark outcomes against nationwide data, according to the APTA.
It came about following several years of discussion on the importance of data to the PT field. "As payment is changing from federal to private payers, and workers' comp is also changing, we're trying to get some ability for us to be more prepared for value-based payment models in the future," said Heather Smith, the APTA's director of Quality. "The hope also was to position us to prepare to think about measures that would be meaningful from the payer, physical therapist and patients' perspectives."
While there are vast amounts of PT-related data collected, it has not been aggregated and analyzed, Smith said. The registry will look at patient populations with the same conditions.
"It will help clinicians understand their cost of care and how they can work with other providers to collaborate and change clinical practice patterns to give the best care to their patients," Smith said. "So you're trying to harness all data from that patient population to see how we might change our practice to change those outcomes."
The fact that the registry is the first devoted solely to the profession comes as good news to therapists. Right now they are taking a wait and see approach to it.
"It has the potential to be good," said Daniel Sanchez, vice president of operations for OnSite-Physio. "It is for PT and about PT, and it's something specific to the PT field. Also, it's based on real-life data."
At the same time, the registry will be open to all types of physical therapists, not just those who work within the workers' comp system.
"One of the biggest limitations of any guidelines is that they are generalized," Sanchez said. "There are outcomes, for example, for all patients with a knee sprain. But there are different requirements [for treatment] if you are a professional athlete, vs. a construction worker or an office worker."
Sanchez also pointed out that not all therapists or practices will be contributing their data, as there is a charge. Members of the APTA will pay $299 per year per provider, while non-members pay $399.
On the plus side, Sanchez is optimistic about the fact that the information from the registry will be based on real-time data. That, he said, creates a real expectation of an outcome — more so than guidelines based on medical research.
(Photo: Shutterstock)
Different types of guidelines
The APTA's Smith believes the information pooled through the registry can serve as an adjunct to other evidence-based guidelines. Medical treatment guidelines that have been mandated in many states for the workers' comp system involve data that has been analyzed, studied, peer reviewed, and met other specific criteria.
"If it is not published data, it doesn't meet the true definition," explained Kenneth Eichler, director of regulatory and outcomes initiatives for the Work Loss Data Institute's ODG, one of the primary national guidelines used in workers' comp. "But that doesn't mean that if some of that data had been transferred to a study it would not meet that definition."
Eichler views data-driven information as another form of EBM. He believes it, too, has an important function.
"Data-driven EBM has a significant place in informed decision-making, and is currently applied in areas beyond workers' comp," Eichler said. "It raises an interesting question: if positive outcomes are documented under a reasonably controlled setting, should [those treatments] be given significant and appropriate consideration?"
ODG actually has a tool that allows subscribers to look up the frequency of treatments performed for specific diagnoses, based on several million workers' comp cases. The information can be vital to claims professionals.
"That data becomes really interesting to case managers, claims folks and actuaries, and it's a really good tool for reserve-setting," Eichler said. "If an injured worker has a certain diagnosis, having this type of data is important to be able to look at the most common procedures so one can anticipate the usual course of treatment to set reserves for them. Also, almost more strongly, it can be a red flag when an injured worker is not receiving the most commonly recorded procedures. That raises questions as to whether the injured worker is being inappropriately treated, or it could mean there is an inappropriate diagnosis, so it becomes a red flag."
Using data-driven EBM in conjunction with research-based data that meets the criteria set by the accepted stringent industry criteria has the promise of providing the best information about medical treatments, Eichler said. He said there are times when real-time data might be the way to go.
"There are many times the payer or utilization review team has the right to authorize something that may not follow the state guidelines," Eichler said. "If they see a request and the [state approved] guideline says 'no,' but the data-driven information shows a majority of people do that, authorizing it might keep a positive relationship with the patient; he won't go to a lawyer, and will probably return to work faster."
At the very least, practitioners are pleased that the new Registry offers a tracking mechanism for PT-related data. They say currently there is nothing like that for the profession.
"We have all this research but what did we do with it," OnSite-Physio's Sanchez said. "The only tracking we've done is because Medicare has forced us to do it. This is a step in the right direction to start tracking the information."
Nancy Grover is the founder and president of NMG Consulting, a media/communications entity based in Florida. With more than 35 years as a broadcast journalist and communications consultant, she is both a media representative and public relations professional. Grover's specialties include insurance, workers' compensation, financial services, substance abuse, healthcare and disability. For 12 years she served as the Program Chair of the National Workers' Compensation and Disability Conference® & Expo. She is the editor of Workers' Compensation Report, a national newsletter, and provides articles for additional publications. A journalism/speech graduate of Ohio Wesleyan University, Grover also holds an MBA from Palm Beach Atlantic University. She can be reached at nancygrover@hotmail.com.
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