A Simple Tool Using AM-PAC “6-Clicks” to Measure Value Added in Acute Care Physical Therapy: The Therapy Value Quotient

Abstract

Background and Purpose: Acute physical therapy practitioners and leaders continue to search for a practical method to measure value. The purpose of this case report is to introduce the Therapy Value Quotient and its simple yet effective use of Activity Measure for Post-Acute Care Inpatient Mobility Short Form, also known as “6-Clicks,” and common payroll data to measure changes in value added to patient care. Case Description: Health care service value should be measured by outcomes produced divided by the cost of services to produce those outcomes. Although acute physical therapy practice continues to progress toward consistent outcome measurement, widespread application of outcomes to quantify value is rare. This lack of value measurement leaves acute care practitioners' value measured primarily in terms of how many units or visits a therapist can code in a certain number of hours worked. Unfortunately, quantities of units or visits are not synonymous with value. Acute care managers and practitioners need a viable and easy-to-use tool that requires minimal data entry and uses existing, easily accessible payroll and electronic health record data. Outcomes: The goal of this project was to create a value calculation with commonly used systems (payroll, electronic health record) data and Activity Measure for Post-Acute Care Inpatient Mobility Short Form data to quantify value. Minimizing manual data entry decreases errors and improves real-time calculations. The purposely minimized design of the equation allows clinicians and managers freedom to create highest-value processes that achieve the maximal value added. Discussion: The Therapy Value Quotient can help managers and clinicians investigate and measure value-adding tactics while improving care delivery and efficiency instead of simply increasing the number of procedures per hour worked.

An Explanatory Model for the Relationship Between Physical Therapists' Self-perceptions of Value and Care Prioritization Decisions in the Acute Hospital

“…Recent work by Hull and Thut49,50 is evidence of effort toward developing and applying a value-based measure. They have described their derivation and implementation of the “therapy value quotient” (TVQ), which accounts for a direct patient outcome (functional change) and indirect therapist efforts (expert clinical consultation of the therapist with nurse or physician) relative to the cost of therapist care delivery.…”

“…23,46,47 Operational measures that would simultaneously account for both (ie, measures of value) are critically needed and are likely to improve alignment between system-and patient-driven priorities. 48 Recent work by Hull and Thut 49,50 is evidence of effort toward developing and applying a value-based measure. They have described their derivation and implementation of the "therapy value quotient" (TVQ), which accounts for a direct patient outcome (functional change) and indirect therapist efforts (expert clinical consultation of the therapist with nurse or physician) relative to the cost of therapist care delivery.…”

Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model

“…For physical therapy researchers and managers, increased transparency in the form of reports and publications may benefit the acute care physical therapy community as a whole. Hull and Thut50,51 have provided a unique example applied to their system, the Therapy Value Quotient (TVQ). However, to our knowledge, the utility of the TVQ has not been reported in other markets, nor is there any published discussion regarding potential uncaptured value to the patient, unit, or system in the aforementioned quotient.…”

Showing Our Value

“…The Journal of Acute Care Physical Therapy reader can search through this publication and find several articles that relate to productivity, value equations, and examine numerous studies that have highlighted our value at an institutional level. [17][18][19][20][21] Recognizing physical therapy positions in acute care is often not revenue generating-we must demonstrate the profession's value to our customers, which includes the patient, interprofessional colleagues, and our employer. I believe most would agree that measures of productivity, while widely used, are not effective indicators of the value of physical therapy.…”

“…The need for physical therapy to prove value has been discussed in various platforms for many years. The Journal of Acute Care Physical Therapy reader can search through this publication and find several articles that relate to productivity, value equations, and examine numerous studies that have highlighted our value at an institutional level 17–21. Recognizing physical therapy positions in acute care is often not revenue generating—we must demonstrate the profession's value to our customers, which includes the patient, interprofessional colleagues, and our employer.…”