Ready, Set, FOTO: Clinical Implementation and Cultural

Integration

The Rehab Associates Way

15th ANNUAL OUTCOMES CONFERENCE

Ryan Webb, PT, DPT, OCS, CSCSJoshua Bailey, PT, DPT, OCS, CSCS, CPed

LEARNING OBJECTIVES

• Initial implementation…it matters• Why putting in the effort makes you better• Implementation for a multi-site business• Day to Day clinical integration• Quarterly review and how to use scorecards to

drive success• Strategic planning with outcomes

Rehab Associates of Central Virginia

Began in 196526 PTs, 16 PTAs with emphasis of outpatient orthopedic PT12 facilities in Central Virginia centered around Lynchburg

Why FOTO?• Collected outcomes data for several years in our

EMR system but it was useless!• Lack of consistency with which outcome tools

were used within the plan of care• Functional reporting G codes• Most of us believed we were good….but we

couldn’t prove• Some weren’t sure they were good enough…until

they proved it

On Your Mark!

Who should do the FOTO roll out?

• Develop a FOTO Champion!

• Preferably not a shareholder

• Minimize variability• Maximize Data collections

• Integrating Data into daily work flowo Frequencyo What to do with the datao Make the right thing be the easy thing

• Common source of information

BEST PRACTICES FOR FOTO ROLL OUT• Educate, EDUCATE, EDUCATE!

o What is it?o How does it integrate into documentation?o What does it mean to me? What does it mean to the practice?o How does the Computerized Adaptive Testing (CAT) work?o How do I get my patients to participate?

• Modeling and scriptingo Avoiding the passive participatoro How to utilize staging within FOTO

A TECHNIQUE FOR FOTO ROLL OUT

• Rolled FOTO out 1-2 clinics per weeko Be present and available:

• Clinicians• Front desk staff• Patients

o It MUST add something positive to the workflow

Daily Clinical Integration of

FOTO

Focus On Therapeutic Outcomes

• This is what we do! o Focus on patient outcomes

• It is where our focus needs to be

• So who cares?o Patientso Referral sourceso Insurance companies

Rehab Associates Best Practices

Intake

Status Reports

Documentation

Goals

Targeted Treatments

Frequency

Intake

Completed with PT – Why? Help the patient understand Accurate medical history Opens dialogue between patient

and PT about function Eliminates problems with tablet Verify the condition and impairment

Intake• When? At what point in eval?

• Using the PSFS • Get patient’s goals• Part of satisfaction survey• Comparable sign

• When to use D/C?• If incorrect medical history • +/- 10% from FOTO mean?

• Import PDF into EMR/EHR– no paper!

• Completed with clinician – why?• Previous intake or status is open for

reference

• Patient may need cueing to think of their presenting conditions vs other limiting factors

• Clarify the patient’s answer to better understand their continued functional limitation

• Import PDF to EMR/EHR – no paper!

Status Reports

Split Screen

Documentation• Copy and Paste from PDF into assessment for

Evaluation and Progress Note• EMR integration is the future

• Update Goals regularly • Document change in FOTO score and specific

functional change• Document change in FABQ

Goals• PSFS – gives you 2 functional and specific goals!

• Preload common goals into your EMR system

• FOTO provides expected functional levels if patient reaches FOTO mean

• Staging – make sure it is appropriate

Goals

Targeted Treatments• FOTO guides targeted functional treatments• Tie exercises to patient goals (PSFS)• Improves overall functional outcome• Patient performs the activity in the clinic• Improves patient’s perceived value• Improves patient satisfaction

Frequency

• Every 4-5 visitso More accurate functional statuso Determine effectiveness of treatment more quicklyo See plateaus

• Frequency reminders

Front Desk• Patient Care Coordinator or Origination

Specialist o Creates patient case when patient is

scheduledo Chooses appropriate conditiono Chooses appropriate impairmento Import PDF into EMR/HERo Complete staff D/C

REHAB ASSOCIATES’TIPS FOR SUCCESS

• Complete the Intake and Status with the patient

• Refer back to previous survey

• Have the patient do the activity in the clinic

• Discuss function, not pain, with the patient

• Complete every 4 visits

• FOTO is a tool

• Use other measures to explain FOTO

• Do we D/C if patient reaches FOTO goal?

• Don’t forget clinical judgment!

• FOTO can be a great tool!!

MAKING THE DATA WORK FOR YOU

Quarterly FOTO Summary reports

QUARTERLY FOTO SUMMARY REPORTS

• Individual reports provided to each PTo GoToMeeting recording

• Directed review o Efficiencyo Effectivenesso Utilization

• Comparison o FOTO meano Company standards

• Immediate Feedback o Opportunitieso Praiseo Education planning

• Easy to store for later reference

QUARTERLY SUMMARY DATA

• Consider providing FOTO awardso Overallo Each body part

• Advertise o Using the website widgetso Blogso Direct mailer marketing

THE WIDGET

FOTO OUTCOMES FOR STRATEGIC PLANNING

• Include FOTO in formal employee evaluation processes

• Developing continuing education opportunities

• Using the data for contracting

QUESTIONS???

Ryan Webb PT, DPT, OCS, CSCSJosh Bailey PT, DPT, OCS, CSCS, CPed