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Clinical Outcomes Becoming More Important in Pitches to Physicians

The free lunches just don't cut it anymore. Not only are physicians busy handling the flood of aging Baby Boomers, they're also bombarded with proposals (and bagels) from PT practice owners.

Uninspired by the traditional pitch-and-pray meet-and-greet with potential referral sources, Integrated Mechanical Care President and Chief Clinical Officer J. Mark Miller refined his approach. He goes right to CEOs and chief medical officers with a simple message.

“You have to put a win-win proposal on the table,” says Miller. “You need to get in there and sell something that's going to make their life easier.”

This offer comes with plenty of appeal to internists and family practice physicians, in particular.

“They are becoming the primary care practitioner (PCP) for the geriatric population,” Miller says. “Seniors often present to the internist with a difficult medical problem only to discover a musculoskeletal problem as well.”

In fact, it's estimated over 30 percent of older patients have a musculoskeletal impairment and PCPs need help to solve at least two-thirds of these conditions.

“We first tell them our job is to make their life as easy as possible as a partner for the resolution of their patient’s musculoskeletal problems,” Miller says. “The opening line is, ‘Everything we do is based on cause-and-effect and here are our clinical outcomes.’”

Those outcomes are becoming increasingly important as Medicare steps up its scrutiny on accountability. The burden of proof makes detailed case studies and consecutive case series data essential.

“Starting in 2019, PCPs will either receive up to a 9 percent increase in pay from Medicare or up to a 9 percent ‘claw back’ based on their 2017 outcomes,” Miller says. Some practitioners are just learning to navigate this system, making it a prime time to take the clinical outcome angle with Medicare practices.

He credits the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) for making outcome-sharing an easy task. The constant measurement of success is essentially baked into the MDT process.

“In one analysis, we studied over 2,800 patients who had conditions lasting 75 weeks or more,” Miller says. “We were able resolve 44 percent with good-to-excellent outcomes. The key to resolution was whether or not their presentation could be sub-classified.”

The evidence-based MDT system begins with a thorough mechanical evaluation to establish a “cause-and-effect” relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.

A systematic progression of applied mechanical forces utilizes pain responses and mechanical responses to classify the disorder. Clinicians then develop a specific plan of care based on those examination results that empowers patients to treat themselves when possible.

“MDT is as powerful a prognosticator for musculoskeletal conditions as there is in all of medicine,” Miller says.

It also lends itself to a physician's approach that is also rooted in cause-and-effect philosophy. Once he explains the method of examination, evaluation, diagnosis, prognosis, intervention and prevention then shows the results, Miller makes a key connection.

“What you've done now is form medical partnership based on consistent clinical processes,” Miller says. “They have a partner who's thinking like them and is going to help them through managing the musculoskeletal problems.”

Follow-ups are extremely important in this relationship.

A regular report of results - Miller recommends every 15 to 20 patients - goes a long way in forming a rapport.

"This way they know exactly what happens every time with every patient, and you can establish yourself as more reliable than a CT scan, MRI or other medical intervention," he says.

It’s also a great opportunity to remind them that they are sharing in the successful outcomes - at no extra cost to them. In fact, steering patients away from imaging or surgery actually improves physicians' standing with Medicare.

“You want to communicate that they're not just a referral base. This is a partnership formed around their needs,” Miller says. “Together, you form strategies to make life easier for the physician, and ultimately, better for their patients.”


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