The reason patient behavior is so darn important

Healthcare as we know it is changing, and this brings providers to a professional crossroads.

On one hand, programs like MIPS bring forth opportunities for physical therapists to prove their worth within the healthcare system (learn more about our ethos on MIPS here). For years surgeons and orthopedic specialists have always had a leg up and reaped the bigger financial rewards for the care they provided. Now with MIPS, PTs have the opportunity to directly compete with these providers and show the low cost, quality care they provide.

That’s a change we’re all ready to welcome.

But the regulations also include a caveat; if a provider doesn’t demonstrate excellent performance, they’re at risk for financial penalties. Even worse, they could get passed over when it comes to participating in value-based contracts.

It’s a major shift in how care is delivered, and changes are coming fast. Providers need to adapt quickly to reap the benefits, as delaying participation can result in major consequences--like a frozen reimbursement schedule.

Given these options, equipping your practice to deliver positive outcomes has never been more critical.

The effects of patient behavior

As a provider, it’s tempting to rely solely on a platform to drive, track and report patient outcomes. If you have the data and know what your outcomes are like, what more do you need, right?

But if you are only looking at your outcomes data without formulating a plan for how you intend to drive patients to take an active interest in their care inside and outside the clinic, you miss a critical element that is directly correlated to outcomes--active patient engagement.

Engaging your patients in between visits is key to not only understanding your outcomes data, but using it to make continuous improvements to the quality of care you provide.

How so, you ask?

Studies show that medical care is responsible for only 10 percent of a patient’s health and well being, but a whopping 40 percent is driven by patient behavior which plays a much larger role in long term health outcomes.

40 percent! 

That statistical difference is a significant reason why engaging your patients outside the walls of your office is critical to establishing good outcomes for your patients-what they do when they are not with you will have more of an impact on their health than the care they receive inside your clinic.

Patients who are encouraged to engage in a platform to complete  their exercises in between appointments, communicate with their provider in between visits, and read educational materials are much more likely to stick with the care program you assign and exhibit positive health behavior - this is where you see results that lead to a good outcome.

Another reason to prioritize patient engagement is that engagement informs your outcomes. Many clinics see a 20 percent improvement in overall outcomes just by seeing their patient satisfaction data, because it illuminates places where you can make improvements in how you engage your patients.

Engagement also leads to satisfied patients and satisfied patients produce exceptional outcomes. 

Take Patient A, for example. Patient A walks into a clinic and is handed lengthy paperwork to fill out, spends minimal time with their busy provider and receives no follow up or personalized care after they leave. They aren’t very likely to feel positive about their experience, are they?

Now, Patient B. Patient B has chosen a clinic that utilizes a patient engagement strategy and platform. The platform makes their digital health survey a breeze, it’s automated so they can see updated and personalized exercises after they leave, and when they have a quick follow up question, they can reach out via the platform and get an answer quickly from their provider.

That is the patient who is much more likely to be excited about coming back, motivated to jump in and get engaged - not to mention tell their friends and family about the great care provided.

A great experience goes a long way toward facilitating a good recovery, and better outcomes. If you don’t utilize patient engagement as a portion of your outcomes strategy, you’re missing out on the opportunity these two things afford one another.

In short, a two part strategy can make all the difference. 

When paired with an engagement strategy, patient outcomes improve exponentially. Simply, engaged patients are better patients and produce better outcomes. 

And as better outcomes will now give you a competitive advantage in MIPS and other value-based programs, exceptional performance can help you get the maximum possible value and the highest possible reimbursement for your clinic, all by simply engaging your patients.

That’s the power of combining performance data with an engagement platform that helps you get to where you need to go.


PS: We're counting down the days until PPS 2019 in Orlando! Will you be there? Come visit our booth #706 to say hi to our team plus join us Friday morning at 7:30 am for a round table discussion with Keet leadership and our industry friends around the future of healthcare. Don't worry, coffee is on us.

therapist on ipad

What We're Reading: October 8, 2019

What We’re Reading

Passing around thought provoking articles at Keet is something of a sport - and this one certainly got everyone’s attention.

>> Walmart unveils major employee health benefit changes aimed at cost cutting

Fierce Healthcare, October 3, 2019

It’s hard to ignore Walmart’s vision and commitment to its worker’s healthcare. The company was one of the first to understand and drive the importance of centers of excellence (which its employees now rave about) and now its rolling out five new initiatives aimed at steering employees toward high-quality providers and reducing unneeded costs. As outcomes are the way of the future, we can only hope that other employers notice their efforts and get on board.

Check it out to learn more about Walmart’s efforts in healthcare. 

Here are the key takeaways:

“Walmart announced Thursday it's piloting several new initiatives in the health benefits it offers workers, aiming to steer employees toward high-quality providers and reduce unneeded costs. 

The company spotlighted five new programs for its 2020 benefits, saying it intends to use its massive size to make healthcare easier for its employees to navigate. The new options build on the retailer’s existing centers of excellence programs, which proved popular with workers, said Lisa Woods, Walmart’s senior director of U.S. benefits, in a statement.

“Associates came back saying, ‘I didn’t know healthcare could look like this,’” Woods said. “They asked us to bring the same transparency, effectiveness, and quality of care to their communities.” 

“I think it’s in line with Walmart’s goal of disrupting and transforming healthcare in a way to promote better value,” he said.

What should you take away from these efforts?

In order to participate in programs similar to Walmart's, you have to stay ahead of the outcomes game and prioritize it in your practice. MIPS is the perfect playground to maximize your reimbursement and begin to demonstrate your value to payers, patients, and potential partners. At Keet, we want to equip your practices with the data you need to be relevant partners for scenarios like this. You’re already great at providing low-cost, high-quality care--it’s time to demonstrate that objectively.

What articles should we pass around next?

Keet Health

PS: We just announced our next webinar set for October 17th that will focus on how to implement a successful MIPS program in your clinic. Hear from a practice that’s doing it right and the steps you can take to get ahead of the game. Spots are already filling fast - claim your seat here

Why PTs have a leg up when it comes to MIPS

We’ve established the benefits of hitching your wagon to a QCDR - but what about the basic benefits physical therapists have when it comes to just participating in MIPS?

One thing we try to drive home at Keet is that participation in MIPS puts you into a pool with all healthcare providers, not only those in the outpatient rehab space. This might sound scary and overwhelming but, really, we think it gives PTs a leg up in being successful. 

Just a quick refresher….

MIPS (Merit-based Incentive Payment System) is broken up into four categories: Cost, Quality, Promoting Interoperability, and Improvement Activities. Each category is towards a 100-point score which then determines whether you’ve earned a positive or negative payment adjustment in your Medicare fee schedule. 

For PTs though, the cost and interoperability categories are crossed out. Those weights transfer over into the quality measures category.

And you know what’s great about that? Physical therapists are already experts in delivering quality care. 

Plus, the cost and interoperability categories are arguably the toughest two to score well in. When you remember the fact that PTs are competing with all other healthcare providers but we’re holding a stacked deck, it’s easy to see why we advocate to take part.  

If you ask us, this adds up to a pretty good outlook for physical therapists participating in MIPS. 

Three ways to improve outcomes through patient education

Many patients experience anxiety when they face recovery from an accident or significant illness. Some have a fear of the unknown, or of the potential pain and difficulty associated with treatment. Others feel intimidated by the financial logistics, insurance frustrations and time involved in getting back on their feet.

These negative feelings can make a patient feel exhausted or defeated before they even begin.

This not only slows them down, but can hurt your ability to help them progress as efficiently as possible.

A great way to overcome this kind of situation is by providing your patients with educational materials about their condition and recovery. This can include something as simple as a welcome email, injury specific articles, an encouraging note about their treatment plan, or clear instructions for things they can do to help their recovery along at home - just to name a few.

Here’s what educating your patients can help accomplish:

  1. It establishes a relationship of respect. Equipping patients with information shows them that you care enough to take the time to engage and include them. This personalizes and humanizes their treatment, and when people feel seen and cared about, it establishes a relationship of respect with their provider. A positive relationship can go a long way toward compliance with treatment plans and overall outcomes.
  2. It encourages active participation in healthcare protocols. Providing educational materials that illustrate a patient’s illness or injury can take the mystery out of their medical condition. This helps alleviate feelings of stress and replaces that apprehension with empowerment. Empowered patients feel more enthusiasm to be active participants in their recovery, making them more likely to follow the protocol you create for them during their appointments and at home.
  3. It leads directly to better health outcomes. An equipped, empowered and motivated patient is much more likely to experience great health outcomes than one who feels anxious, overwhelmed or dismissed by their provider. Feeling positive helps patients communicate more effectively with their provider and put more energy into their treatment, speeding up their healing time and the likelihood of a great outcome.

Education creates a safe space for patients.
When a provider takes the time to educate a patient, it can help the patient have more faith in the process and motivate them to be more involved in their care plan. Education helps create a safe place for patients to take ownership of their treatment and overcome their injury, and is another great way to deliver value as a provider of excellence.

Did you know you can add custom education pieces in Keet? Just another way we’re reimagining recovery.

The 411 on hitching your wagon to a QCDR

QCDR - just another acronym or much more?

First off, what’s a qualified registry? A QR is capable of collecting and submitting quality data to CMS on behalf of clinicians.

A Qualified Clinical Data Registry, or QCDR for short, is defined as a CMS-approved entity that supports the collection of clinical data for the purposes of patient outcomes tracking to foster improved care within a clinic. 

So, what’s the difference between a QCDR and a qualified registry? 

Whether you are required to participate in MIPS or you’ve chosen to voluntarily report, you have an option with which reporting route you take. 

A qualified registry and QCDR are similar, but unlike a qualified registry, QCDR reporting options aren’t limited to measures within the quality payment program and they can also submit data for the Improvement Activities category on behalf of clinicians. 

Speaking of Improvement Activities, participate in MIPS via a QCDR and you will have an immediate upper hand in the Improvement Activities category since the use of a QCDR is considered a “high-weighted” activity. 

What that means is, if you want to score well in MIPS, reporting via a QCDR is your best bet. 

So, yes, it is much more than just an acronym. QCDRs are the best vessel for submitting MIPS quality and improvement activity and you should absolutely hitch your wagon to one if you’re hoping to be successful in MIPS in 2020.

The Micro and Macro Value of Outcomes Data

Through the creation of the Quality Payment Program, Medicare has provided a glide path for the transition to fee-for-value.

The first step of that journey is MIPS. 

Think of MIPS as an olive branch from CMS to providers, tying quality performance to reimbursement. CMS could have immediately forced all providers to participate in value based contracts, but instead, they have offered a slow transition so we can all ease into the world of value-based care. 

The Gold Standard

There’s a reason Medicare considers patient reported outcomes the gold standard--they’re proven to provide quality data to improve clinical performance. MIPS provides an incentive for providers to get serious about collecting patient outcomes. 

The Micro Utility of Outcomes Data

Improving care delivery starts with objectively knowing how your patients are doing. Evaluating patient reported outcomes on an individual basis, allows you to deliver more personalized care--but the utility of these measures shouldn’t stop there. 

The Macro Utility of Outcomes Data

Once you can look at outcomes data in aggregate, the utility significantly increases. The advantage of the macro data is the ability to leverage your outcomes to evaluate and improve your clinical performance and create evidence-based protocols. When providers are given visibility into patient-reported outcomes they’ve seen a 20% improvement in clinical performance. 

How are you looking at measurement in your clinic? Let us know in the comments. 

therapist with patient

Five Ways to Better Communicate with Patients

Clear communication is vital in building and maintaining effective relationships with your patients.

When it comes to patient-provider communication though, more often than not, the burden is put on you as the provider to communicate better with your patients.

But what about how patients communicate with you?

Some patients come to their appointments with a list of questions in hand; this isn’t their first rodeo and they came prepared. Others don’t know how to communicate how they feel or what they need, which can be overwhelming for both of you.

Fortunately, a bit of guidance can go a long way.

One of the most valuable steps you can take to build a trust-centered relationship with patients is providing a resource up front that sets expectations and fosters productive discussions between the two of you.

To empower your patients from the get go, teach them how to be exceptional patients. By helping them understand what you expect of them and what they can expect from you, it gives them agency to work towards shared decision making with you.

Prioritizing thorough communication with patients can help them feel more positive about their treatment plan, which can lead to increased compliance with your suggestions and ultimately lead to more positive health outcomes. An engaged patient is a healthier patient. 

Making it easier.

Since we know the responsibility of communication usually falls on your shoulders as providers, we created a tip sheet you can print out and give to patients to help them be even better patients.

Like we’ve said before, we don’t think patient engagement is a software solution alone, incorporating resources like this into your patient engagement strategy can go a long way in helping establish trust with patients and building your practice reputation.

Check it out here. We even made it editable so you can adapt it to your office needs as you like.

therapist working at computer

3 Reasons to Participate in MIPS Even if You’re Not Required

With talk around MIPS only getting louder, there are a lot of PTs left wondering what all the commotion is about. Afterall, for over 90 percent of physical therapists, reporting for MIPS in 2019 was optional. You could chalk up the program as just another reporting burden, but the question remains, is that wise?

Given that you can participate in MIPS as long as you meet one of its three key thresholds (care for at least 200 Medicare beneficiaries; have $90,000 in allowed charges for covered services; or provide at least 200 such services under the Medicare Physician Fee Schedule), what do you stand to lose by not opting in? 

Here are our top three reasons to participate in MIPS - even if you’re not required.

  1. MIPS provides you a chance to improve your practice and patient care: Most PTs are in the profession for a reason: to make a real difference in patients’ lives. On top of everything else, participation in MIPS incentivizes providers to take a critical look at their practice and the assumptions they’ve made about how it should run. Think of MIPS as a push in the right direction—toward efficiency and quality, but also toward things like better patient engagement, and even toward administrative improvements like better data collection.
  2. It provides an opportunity to prepare for the shift to advanced payment models: Plain and simple, by the year 2022 all Medicare providers will be required to participate in the Quality Payment Program (QPP). MIPS is designed as a hybrid program — a combination of fee-for-service with quality incentives. The long-term goal of CMS, however, is to move all providers to alternative payment models (APMs) where reimbursement depends entirely on care quality and cost-efficiency. PTs who decide to not participate in MIPS may miss their only chance to make that transition gradually.
  3. Your MIPS score can earn you a role in the self-insured market: More and more employers are taking part in the self-insured market as it gives them flexibility in customizing plans to meet the specific healthcare needs of its workforce, among other benefits. With low back pain so prevalent in America’s workforce, many employers are looking to physical therapists in their communities to provide care to their employees and prevent both absenteeism and presenteeism in the workplace. How are employers choosing the physical therapists for their provider networks? Through available data like MIPS scores which can indicate the PTs who provide the most effective care. Decide to sit on the MIPS sidelines and you could be missing out on this huge opportunity.

therapist on ipad

What We're Reading: September 3, 2019

To say we read a lot at Keet is an understatement. It's rare for a conversation to go by without someone dropping a reference to a recent book or article they’ve read. So today, we thought we’d bring you into the fold.

This week we’re sharing two articles that have been circulating Keet recently.

What We’re Reading

>>America’s elderly seem more screen-obsessed than the young
The Economist, August 14, 2019

This article got passed around the Slack channels at Keet when it was first published—and for a good reason. One of the most common objections we hear in the market is that older generations will never adopt a technology like Keet. In evaluating our data, we’ve found that’s not the case. We've learned that our most active users at Keet are baby boomers and medicare patients—not 25-year-old millennials.

Check it out to see how technology has permeated the lives of Americans of every generation.

Here are the key takeaways:
“Many parents and grandparents will grumble about today’s screen-obsessed youth. Indeed, researchers find that millennials look at their phones more than 150 times a day; half of them check their devices in the middle of the night; a third glance at them immediately after waking up. And yet, when all screens are accounted for, it is in fact older folk who seem most addicted.

“According to Nielsen, a market-research firm, Americans aged 65 and over spend nearly ten hours a day consuming media on their televisions, computers and smartphones. That is 12% more than Americans aged 35 to 49, and a third more than those aged 18 to 34 (the youngest cohort for whom Nielsen has data).”

“Most of that gap can be explained by TV. American seniors—three-quarters of whom are retired—spend an average of seven hours and 30 minutes in front of the box, about as much as they did in 2015 (this includes time spent engaged in other activities while the television is blaring in the background). They spend another two hours staring at their smartphones, a more than seven-fold increase from four years ago.

What have you noticed in your own family?
We shared many stories this week of our grandparents on iPads, their first experiences with Amazon, and how they’re more informed on some of the latest Netflix shows than we are.

While it might be a shock, consumers aged 18 to 49 spend the least amount of time in front of a screen. The biggest offenders? Baby boomers and up.

The data continues to support that seniors aren’t shying away from software, which means we needn’t shy away from incorporating technology into a patient engagement strategy.


>>Physical therapy can be too much of a good thing: Study
Business Insurance, August 21, 2019

While this title sounds alarming, it brings to light a problem we see in the medical community every day—the volume reward. This article examines a study on the excessive use of physical therapy and whether or not it’s a cost driver for workers comp payers and could possibly stall employees from returning to work.

The results? That the cost of physical therapy can skyrocket with 15 sessions or more. Check out the full article here. 

Here are the highlights: 
“Physical therapy is a wonderful thing; it’s just when it’s abused,” said Dr. Ed Bernacki, a professor of population health with the Dell Medical School at the University of Texas at Austin, who co-authored a study finding that the costs associated with 15 sessions or more of physical therapy can be close to double to costs of ten to 14 visits.

The study, published in August’s Journal of Occupational and Environmental Medicine, provides data sourced from 197 comp claims in Texas between 2013 and 2017. The report concludes that excessive physical therapy—15 or more visits—can increase claim costs more than other well-known cost drivers such as comorbidities, opioid use, and legal involvement, and can keep claims from closing.”

The interesting thing we are finding is (the correlation between) when physical therapy starts and outcomes; if you dig in (the data) you may find physical therapy starts later, two to three weeks out (after the injury),” he said, adding “that delay leads to higher claims costs and longer disability and longer physical therapy.

“They start the case off wrong in the beginning,” he said. “I would advocate that if quality care was provided early on, it would have a significant impact on duration and level of function at maximum medical improvement.

Our take:
Whether it’s prescribing medication or physical therapy, leveraging outcomes data to create and support a plan of care is crucial. Without it, excessive care can become the norm and ultimately increases costs for everyone involved. Though we're not naive, as long as the system rewards providers for volume, this problem will persist.

However, as we move to value based care, collecting patient reported outcomes and creating evidence-based care pathways not only leads to improved outcomes, it helps providers compete on their quality of care. And we’re here for that. Nothing excites us more than being able to help providers like you objectively demonstrate care quality.

What’s your take? We’d love to hear. Leave us a comment below and let us know.

What are you measuring?

In business, we constantly strive to define metrics because we know that what is measured can be improved. And more specifically, what you choose to measure shows what you value. 

At Keet, we have a joint vision with Clinicient to improve 20 million lives by 2025. As a result, we have a daily feed displayed on a dashboard when you enter the office with the number of lives we’ve impacted to date.

However, figuring out what to measure can be difficult. When it comes to our dashboard, we had to strategically evaluate what constitutes “improving lives.” Did it mean the number of patients going through our system? Did it mean the number of patients who stay engaged in the app past a certain date? Did it mean… our conversation went on for quite some time.

When it comes to a clinic, the metrics that matter aren’t how many patients are coming through the door--it’s how effectively you’re able to treat patients, and how predictably you’re able to treat similar cases. 

What do your metrics say you’re valuing?

If you’re a provider considering what MIPS means for you… 

MIPS offers a standardized structure for measurements across specialties. While you may not be required to report this year, by 2022 every Medicare provider will be required to report in the Quality Payment Program (QPP). To stay ahead of the game, it’s best to know how successful you are now so that you can begin to improve strategically and compete on quality. Keet can help.