Episode 15
Allison: Good morning, good afternoon, and good evening, and welcome to the Therapy Matters podcast, your one stop resource for expert insights and advice on everything therapy and rehab.
I’m your host, Allison Jones, and today, I’m joined by Eric Herman, co-owner of Buffalo Rehab Group. Eric, thank you for joining me today.
Eric: Thanks for having me.
Allison: It’s great to have you on the show. Before we dive into today’s topic, I want to give our audience a little bit of background on who you are. Just take a minute to introduce yourself and tell us a little bit about your experience, a little bit about your clinic.
Eric: Yes, sounds good. I’m Eric Herman. I’m the chief clinical officer for Buffalo Rehab Group Physical and Occupational Therapy. We are located in Buffalo, New York. We have soon-to-be 14 clinics. We brought OT to our company just two years ago.
We’ve been physical therapy since 1990 and I started with the group in 2002. In 2017, myself and three others started taking over the running of the clinics, which have since then grown substantially. My role as a Chief Clinical Officer is to ensure that our clinicians have the skills needed to provide our patients with great outcomes and great experiences when they are with our clinics.
Allison: Excellent. All right. We’re going to talk a little bit about outcomes today. But first let me just do a quick introduction to our topic. The last few weeks on the podcast, we’ve discussed three major challenges and opportunities facing Rehab therapy. We’ve talked about reimbursement, workforce, and technology, and we spent much of our time on reimbursement and workforce issues.
So, today it’s all about technology and specifically using technology for better business and patient outcomes and Buffalo Rehab has an interesting technology story. Your clinic has leveraged various technologies to help understand your business and also help create better outcomes for your patients.
What I’d love to do today is dig into that and learn a little bit more about it. Does that sound like a good start?
Eric: That sounds great.
Allison: All right, what I’d like to start with is business intelligence. This is a hot-button issue. Lots of people talk about it, and quite frankly, a lot of rehab therapy folks don’t quite understand how to leverage business intelligence correctly in their practice. When did you first start using B.I. in your clinic?
Eric: We started using business intelligence right around the time that we took over. It was like 2016 or 2017. We brought on Domo, which is a business intelligence platform to connect our different departments. We’ve been using a FOTO for our outcomes tool since 2013 and merging that with QuickBooks and our scheduling software because we didn’t have EMR back then, but now we also attach it to our EMR system too.
That allowed us to look at how different points relate to each other: how our scheduling impacts our outcomes, how our outcomes impacts our finances, and how our scheduling impacts our finances. We start to connect these dots and really learn what helps for successful outcomes and also helps to keep our business successful.
Allison: What was the driver behind bringing B.I. into the clinic?
Eric: Understanding and trying to gain knowledge so we can coach our teams on what really matters. The idea that having knowledge is one thing, but how do we apply the knowledge we’re gaining? Are we noticing similarities between what relates to a successful outcome with FOTO and what keeps our business moving in the right direction financially?
As we start to learn what works for our more successful clinicians. Are those clinicians based on their outcome scores also successful based on revenue gain from those clinicians too.
It’s real nice that with FOTO, we were able to delineate between different body regions. As we’re treating someone with the spine, we understand certain clinicians are more successful with their outcomes and maybe their scheduling habits with one area, like the spine, because they’re more comfortable treating it. Maybe that doesn’t relate to when they treat shoulder patients. We get a chance to dive in a little deeper on these individual body regions and have more successful coaching sessions with our team.
Allison: How did you go about choosing your vendor of choice for a B.I.?
Eric: It was prior to us having EMR. A lot of the EMR software that I know of, when we were vetting them, has business intelligence built in. Well, we didn’t have that. When we were looking at different tools, we had everything available to us. It wasn’t already trimmed down to, “Hey, you’re already using the CMR software, so use this business intelligence tool.”
So, my business partners, they were looking into various ones. One of my partners codes, so he’s a physical therapist by trade, but he taught himself coding also. He felt that Domo was the best one for him to work with. It’s nice having Steve on our team. If he sees something, he messes around with coding so he tells me not to touch the wrench or screw anything up and he’ll be able to write the code and then analyze the next thing.
We have strategy sessions where if one of us is seeing something, we say something and problem solve. Is this the next thing we should be looking at? We do that on a fairly regular basis. Is what we’re doing the best? Each year, we learn something new: maybe we should be looking at this data point instead and try to get to what are the lead indicators that really move the needle.
We’ve learned a lot in the last three years, and it seems like we’re onto something that sticks. Then, six months later, we find something else. Maybe this is the thing that will help make it relatable to our clinicians because ultimately, nobody loves talking about data in physical therapy. It’s—
Allison: It’s not the fun part.
Eric: Right.
Allison: Digging into that, if you don’t mind sharing, what did you learn last year and maybe looked to apply to improving this year in your clinics?
Eric: Yes, I think the biggest thing that we really pushed our clinicians to do is to schedule at their evaluation, schedule out patients for trying to get the full plan of care scheduled on day one. We noticed that the best outcomes happened with the patients that were scheduled out for their entire plan of care from the beginning.
Our target now is that our clinicians average 42 days, or six weeks of scheduling at their evaluation. The uncertainty is there when you’re seeing a patient for an evaluation, but what I do know is that patients that get the best results are working with me and my team for at least eight weeks. The highest outcomes occur when they’re really getting back to life—that’s what we’re trying to do, help people get back to life.
If we educate our team on how to get two-thirds of your patients better, and we know this from using our FOTO data from 2013, that two-thirds of patients have results greater than FOTO outcomes if they’re seen for eight weeks. Again, we get 80 percent of our patients through a second FOTO test. This is based on 80 percent of the patients that we see. If we talk to a new grant and say, “Hey, you want to get two-thirds of your patients better and know they’re better? See them for eight weeks.”
The sooner we educate them on what the scheduling is going to be, and not go visit week by week, we’re more likely to have that successful outcome. That’s the biggest thing that we noticed. We knew that we needed to see patients, but then last year we realized that it was the ones that we actually schedule on day one for their journey, their plan of care journey, had successful outcomes.
Allison: Is that just because the patient then just understands what they’re committing to? They understand what their journey is going to look like and what they’re going to have to do to get to that healthier place?
Eric: Yes, we coach our clinicians on setting out the journey. We call it “whiteboard wisdom” where we teach our clinicians how to have the conversation with the patient about the process and the expectations of physical therapy. It’s not going to be something that tomorrow it’s going to be magically better.
This is something that we need to make changes and our body adapts and changes, and then we need to adjust the programming based on how the body adapts and changes. That’s what we learn in school, and I think sometimes we forget. There isn’t anything magic about this; it’s creating change over time, and that’s how our body will be strong enough to do the things that we want it to be doing.
We coach this to the patient on day one, but then we say, “I’ll see you Thursday,” and you only schedule one visit. You didn’t set that patient up for success if you only scheduled that one visit because you talk to them about it being a 12-week process for us to get you better and then you didn’t commit to that 12-week process. You didn’t have the patient commit to the 12-week process because you just scheduled them two days later, and that’s it.
We found that clinicians who didn’t just coach the process but also took active steps toward that process and scheduling the patient out had the best outcomes. This is the cool part: using our business intelligence, we’re able to see this. Our office leaders, regional coordinators, and I get this data on a daily basis. It’s automatic. There’s no guessing.
Our coach-ups then focus on identifying barriers to helping this patient reach their outcomes, to complete their plan of care journey. And we can say, “One of them is not scheduling them out for their plan of care on day one.” We know this as a great lead indicator for having a successful outcome with the patient.
Allison: I know patient outcome is the number one priority, but second to that is revenue and making sure that you’re getting the visits. I would imagine that establishing this and using this approach also helps you maintain a very steady revenue stream.
Eric: Right, because you know what’s coming then too. It helps all aspects of it. It helps our patient service team to know what the schedule looks like, what someone’s schedule looks like two weeks in advance too. We can then plan for new patients that come into the system.
If we’re taking care of our set schedule as new patients call, we’re going to know where that availability is and I’m never double-booking myself. If I don’t have patients scheduled out, it’s my fault that an evaluation gets popular on my schedule where I know I would have this person that I’ve been seeing for the last three weeks. I know this is my five o’clock on Monday.
If I don’t have that scheduled out, I might have an evaluation two weeks from now at five o’clock on Monday because I have not continued to schedule that. Not just for future revenue because the visit is on the schedule, but also it makes my schedule easier long term.
It makes other departments within our team and other teams within our company able to do their jobs more effectively. It’s our easiest form of communication between departments to have a clean schedule.
Allison: I’m curious does this also tie in with patient satisfaction and levels of patient satisfaction with just understanding.
Eric: Yes. Completely, it’s understanding. That was the word I was going to choose; they understand what to expect. So, patients, when they’re done with us the first day, they’re going to double-check everything you said. They’re going to go to Dr. Google and they’re going to ask, “Does everything this person told me make sense?” If we haven’t given them their expectations properly, they’re going to formulate their own expectations. If we’re not meeting the expectations they’ve come up with on their own, that’s when dissatisfaction happens.
Our role, I’ve said this for years as I’m coaching clinicians, from the first day is to give a patient hope, and how to build that hope is to really have a great plan. If you formulate this great plan, you’ve given them hope, and now when they go to double-check, they’re going to find something that matches.
For example, the normal healing time of the body is eight weeks, or when I tell somebody it takes three weeks to gain mobility and flexibility through consistent stretching, they can find that online, and they will find that online. I don’t mind them looking up, but it all starts because I gave them the expectations, and again, the really cool part is that the follow-through is scheduling from the very beginning.
We’ve learned that as a clinician, committing to these times, and then the patient committing to those times, and as long as we’re going through this process and following up, that’s when satisfaction is high and stays high.
Allison: Right, so there’s no frustration on the patient side trying to call and get an appointment and not having something available, and then trying to manage schedules. All that frustration, being a patient and having done PT, could derail pretty quickly—me coming in and getting the care that I need. This just popped into my head as you were talking, somebody once told me that PT hurts. Therapy hurts. You have to work really hard to convince your patients to keep coming back.
Eric: therapy hurts. That’s an interesting one.
Allison: As part of the healing process, it hurts a little.
Eric: Yes, but if there’s a good understanding of what we’re doing, why we’re doing it, then maybe sometimes that hurt has value. Therapy is challenging because we’re trying to create change. I usually say, instead of therapy hurts, that nobody really wants to be in therapy. They’re making a choice to be there.
We should feel privileged because the patient is choosing to be with us instead of all the other cool things they could be doing with their time. They’re choosing to be with us. We better provide that value each time they come in. So, the successful encounters are each moment we have with the patient that is our opportunity to provide value beyond someone’s expectations.
We use NPS, the net promoter score, for our patient experience and satisfaction, and we capture that at six days after the evaluation and then at 30 days after our evaluation. We also allow our clinicians to send an NPS questionnaire throughout the process. As they’re hearing from their patient that they’re valuing the journey, they can send an NPS questionnaire to capture those positive success stories.
Giving our clinicians the power to send it was important, and that’s something else we just recently added. We value the information so that we can continue to learn from it. The truth is that there is a correlation between successful patient experiences and scheduling. It’s pretty cool to see how it touches all the different points in our team.
Allison: Absolutely. I want to go back to when you mentioned that a lot of people don’t get excited about data. You have to make it exciting for your clinicians to engage with it, understand it, and really leverage it. So how do you make it exciting for them?
Eric: It starts with understanding why. I can talk about my own experience when we first were looking at bringing FOTO to Buffalo Rehab Group. I have to say I was a little reluctant, even though in my role at the time, I was one of our clinical quality specialists, not in the current role I have, but definitely, a coaching role. I thought I was a great clinician, and I felt that I was a great clinician. I had patients coming back to see me because of the previous successful outcomes. I had physician groups that were specifically referring to me only, and I had patients that would refer family and friends.
All those indicators that tell you you’re doing a great job. But then to have actual data to measure how successful I was with patients, that’s a little nerve-wracking. Fortunately, I did learn that I was good at what I was doing. But I did learn that there were areas where I could improve my treatment strategies.
That’s the cool part about it. It depends on how you perceive the information you’re gaining and if you’re using it as a way to improve yourself and grow and improve the strategies and systems and processes you have in place. It’s not as scary if it’s not measuring or demeaning in any way. It’s more about where can we help you have more successful outcomes, getting our team to understand why we’re measuring and looking at each thing.
A lot of what we’ve done is we’ve changed to, I guess for lack of a better term right now, harping on the actual number. We want to see our clinicians be at 120 percent of FOTO-expected outcomes, 20 percent higher than the national averages. But we don’t push them so much in that department. We look at it as we want you to actually do FOTO, so the number we harp on and push is your utilization number. We just want you to capture results right now, and that’s the thing to focus on.
Our performance bonus is that you’re getting 80 percent of your patients with follow-up surveys and that you’re capturing more than 45 percent of your patients on NPS surveys. It’s super awesome. 65 percent of our patients give us an NPS, and we’re at 80 percent of our patients. Yes, we get FOTO outcomes at 80 percent of our patients. We perform as a bonus, not on how successful our outcomes are. We find that we get more truthful feedback from patients that way.
Our clinicians aren’t so worried about the results, which then allows us, after we get enough data, to give them some truthful feedback instead of having cherry-picked data, so to speak. We just want to help people be better. That goes with our patients and also our team. We want to see our team be successful and continue to grow in the way that they want to grow and treat the patients they want to treat. They come to work and they’re passionate about what they do. We can create processes that allow us to improve upon that. We’re always looking.
Allison: That’s awesome. So, bottom line: How has all of this technology helped you run your business and better provide treatment and outcomes for your patients? Let’s sum it up.
Eric: We’re continuing to learn, and we’re not afraid to have been wrong. We’re looking to advance not just our team, not just our patients in life, but also the profession. We really are trying to be innovative in what we’re doing and to be able to tie everything back to successful patient journeys has been very rewarding, especially for me, I’m the clinical educator for our team.
My goal is to have the best clinical outcomes, and it’s really neat to see that successful patient journeys equal the best outcomes equal the best patient success stories and a feeling of value with their time with us, but also helps to drive the revenue too.
When it comes down to it, we’re able to leverage the technology that we use to measure and make sure we keep measuring to find the best measurement for successful patient outcomes. Because that’s what’s going to continuously drive our business in the right direction.
Our clinicians will feel more successful as they continue to grow with us because they’re seeing more positive outcomes with their patients and completing patient care. We’ve been able to continuously modify what we’re coaching our team and what we’re measuring by being open to learning.
Allison: Excellent. Any advice for practices out there that are looking to dip their toe into technology to help them improve outcomes, processes, and workflows. Any advice for them on how to get started?
Eric: Educate your team on why and what’s the most valuable piece for the business, for the patient, and most importantly for the clinician themselves. That’s when you’ll get the best buy-in. How does it affect, how does using the data positively impact the individual clinician? You need to hit that first. If you don’t hit that, they’re not going to have the buy-in to follow through with it, and they’ll be frustrated by the fact that you’re measuring them. Start with that why first.
Allison: Excellent. Well, this has been a wonderful conversation. I think we could probably go on for quite a while but we are out of time. I really appreciate you joining me today.
Thank you so much for being on the show and thank you to the audience for tuning into the Therapy Matters podcast, your one stop resource for expert insights and advice on everything therapy and rehab. We look forward to seeing you on the next episode. Thank you so much.
Eric: Thank you.
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