On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Michelle Collie on the show to discuss the importance of outcomes and how they can make a difference in your practice. Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.
In this episode, we discuss:
Resources:
The Outcomes Summit: Use the discount code LITZY
For More on Dr. Collie:
Born and raised on a sheep farm in New Zealand, Dr Michelle Collie spent her childhood years training pet sheep, riding motorbikes, and eating enough lamb to last a lifetime. She earned her bachelor’s degree in Physiotherapy from the University of Otago in 1994 then moved to Rhode Island due to the United States Physical Therapy shortage. In 2003 while pursuing a Master of Science and Doctorate of Physical Therapy from Massachusetts General Hospital’s Institute of Health Care Professionals, Michelle became the owner of Performance Physical Therapy. Under Michelle’s leadership, Performance has grown to a practice with 13 locations in Rhode Island and Massachusetts and over 200 employees.
Michelle is an APTA member and serves as the chair of the private practice PR and Marketing committee. Performance Physical Therapy has received a number of awards over the years for its business success and philanthropy, the highlight being the recipient of the 2014 Jane L Snyder, Private Practice of the Year. She is a board-certified Orthopedic Clinical Specialist
Read the full transcript below:
Karen: 00:00 Hey Michelle, welcome back to the cloud cast. I'm happy to have you back.
Michelle: 00:04 It's great to be here. Karen, thank you for having me.
Karen: 00:07 Of course. So today we're going to talk about outcomes, specifically outcomes within your clinic and with your patients. But I think before we get into the meat of this talk, I would love to hear from you what your definition of outcomes is.
Michelle: 00:24 Well, um, hopefully I'm not quoted by the Webster dictionary or anyone else out there, but for me in my practice is a physical therapist. To me, outcomes of the results that are numbers and they could mean practice management outcomes such as how many patients we see visits in an episode in here. They could be outcomes related to patient satisfaction such as your net promoter score or how many Google reviews did you get. Or they could also be clinical outcomes based on such things as the specific clinical outcomes means, Mitt measures that we use, whether it's related to the Oswestry or a disability scales. So those are just examples of some of the outcomes. But I think outcomes are like the results, tangible numbers of behind them. So you can actually give some, um, objective measures behind what these outcomes are.
Karen: 01:19 Right. And you S uh, I like that you kind of put those outcomes into different categories because when I hear outcomes I just get incredibly overwhelmed and think, well there's, there could be so many. Right? So thanks. No. So now we kind of have a defined how do we measure outcomes within our practice? And maybe you can give some examples of what you guys do, but is there, do you have any standardized ways that you are measuring these different outcomes?
Michelle: 01:50 So again, we can classify it into different ways and I will bring out one, one methodology actually is when it comes to practice management outcomes, that's something you hear often, especially with the benchmarking program that happens through the private practice section. We start looking at outcomes and using numbers to benchmark against each other. And those are things such as, um, how many, how many visits in an episode of care or how much revenue do you gain per patient visit? So these are things that are very much financial and operational defined and how you figure out business wise how well you're doing. So that's one side I'm going to flip to the other side, which I think is much more exciting to talk about for most people and that's actually our clinical outcomes. How good a job or how well are we doing when it comes to treating our patients?
Michelle: 02:47 And there's such a drive now to looking at our outcomes as far as our clinical outcomes and what does that truly mean? Does that mean that my practice or Misa physical therapists get someone better and less visits or at least amount of time or with more intervention or different combination when, how much better do we get someone? So the outcomes to me relate around time, which could also be actual number of visits or encounters and also is how much bitter someone gets. If I'm treating a runner and they, our goal is, Hey, I want to run a marathon in four hours, am I being sucks? Can I get them back to being able to do that? And can I do that just as well as not just the next physical therapist, but other fitness, health care provider, whoever that is. And how can these outcomes?
Michelle: 03:42 So how do measuring outcomes help to drive your practice? So I guess this is a really, what you're counting down to was the why. Why bother doing this? And so yeah, this is getting to the why, which is the most fundamental part is by measuring our outcomes and helps us differentiate. Now when we can differentiate ourselves, it makes it easier to do marketing and that marketing can, it can impact us in different ways. We can use it to market to get more patients. We can use it to negotiate, which is marketing messaging with a payer, whether that's an insurance company or whether someone's paying cash for services that we now have outcomes, which is data to help him messaging and differentiate, here's what I can do or my practice can do. Um, so I think there's many different levels, um, that it relates to, but it's all comes back to marketing and messaging and being able to differentiate and communicate to the consumer and will the payer about what our services can provide.
Michelle: 04:54 And can you give an example of how you, you and your practice might use your outcomes to market and you can choose if you want to market to a payer market to the general public, I'll let you choose. So we've done a whole bunch of things that our practice and hit a lot of success. Um, one is marketing and this is probably the easiest one for people to understand marketing to physicians. So with the data that we have, I can go to a physician [inaudible] physician group and say, Hey, here are end results. If you, when you refer a patient to us, we're going to get them this much theatre and here's what the national benchmarks are. So we're actually proving to you that we're going to get the results that you want and guess what? I can and we're actually gonna do it at least visits and what the national standards are.
Michelle: 05:51 Now I can compare as cells to um, we, I compare as to practice nationally or regionally or even over time. Look, we put these new systems in place or we started try needling or using this new blood flow restrictive therapy or whatever modalities or treatment methodologies we're using and say, because of this, now we're now we have the data to show how much better we're getting patients. And then for us it's actually really helped to Provo provide actually data to referral sources and they can actually say, Oh, so we're going to seam patients to you because you're actually going to provide solutions and get our patients better. It's not just about the fact that Oh, you've got more clinics or you are open on Saturday mornings and no one else is, or you had fancy equipment. I mean these are true differentiators, not just things we can do to make ourselves look better.
Michelle: 06:50 I think that's the big thing. I think, you know, years ago I always used to think that marketing and promoting your practice was just simply about relationships. And if people like you, they'll send you patients and patients like you, they'll come back to see you and all those. Although those things are true too a little bit when you've actually got the data behind you and really meant, helps you tell a story and say, Hey, this is why we should be treating your patients or to the general public. This is why you should be coming to physical therapy to help with your back pain or your ankle sprain or your pelvic health problem or your dizziness. You've got the numbers to show that we will get you better.
Karen: 07:31 Yeah, and I think it's great to use numbers because these are our facts, right? You're not fudging these numbers. This is the actual data that is coming out of your clinic. So I think it's great to be able to then instead of just have the data and say, Oh great, look what we did. But you want to use those outcomes in order to market your clinic.
Michelle: 07:56 Exactly. And I think the other nice side about it as when you're using the data to market, it actually changes the culture within your clinic and within your practice.
Karen: 08:07 That was literally my next question was how did outcomes affect that people working day to day in your practice?
Michelle: 08:13 Yeah, well I think it's really helped to make us practice and every visit make all of our clinicians and their patient care coordinators and our assistance and our exercise specialists realize, yes, we're very concerned about customer service and giving, um, you know, having beautiful clinics and all of these other aspects. But at the end of the day, we need to make sure that every moment we're spending with patients is designed to get them back to be doing the things they want to do in this got a show in the data. Yeah. And I think it's helped to really drive our clinic and the kind of care that we're providing. So it's not just about, Oh, I'll collect the data and now I'm going to get paid more by an insurance company. Or now people are going to come and see us or doctors or refer. It actually drives the culture within a clinic to ensure that you, I always feel like we've got rid of complacency which can sometimes creep and practices. Yeah. And how do,
Karen: 09:14 how do you use this, the outcomes data to kind of align with your vision or the or the mission of your practice? What would you say to other clinicians when it comes to aligning the data with the mission and vision?
Michelle: 09:30 Well, I think that's really a great point you bring up because people often say, well how do you know what to measure and why are you doing this? And I think it always starts with your strategic plan and figuring out, first of all, what is your purpose? Which is like your greater good. Why do you, why you in practice and what's it all about? And then thinking, okay, well then what's their, what's their mission, what are EMV values? And once you figured those things out, then you can challenge yourself and say, well how am I going to prove it and how am I going to measure it? So that when someone says to me, Oh, your purpose is about having a healthy, fulfilling the film happy community, and you're helping your community to be in that way, how are you going to truly measure that?
Michelle: 10:13 That's what you're doing? So I think you have to start with that strategic over powering, look at your vision, your mission, your values and names going on. How am I going to measure that and not the other way round. Mmm. We see like, yes, we're going to look after our community and then we're going to use innovative results given here and now it's like, well, how are we going to prove that? I'm like, the only way you can prove that you're getting results driven, innovative care is by showing the data because otherwise it's just talk [inaudible].
Karen: 10:48 Yeah, yeah. No, that's great. As you're saying this, I'm thinking about my mission for my company and like, Hmm, yeah, okay,
Michelle: 10:59 how am I going to measure this now? And it's not, you're not going to come up with it overnight and there's no perfect way to do it because this is quite a new area for physical therapists or we're only just part of this evolving healthcare environment where payments changing and with payment changes the messaging of how we're promoting what we do, but it is turning into much more a shift away from fee for service and much more to say like we're paying for the outcomes or the experience, not how many visits or how many units of charge per visit or how many visits and an episodic here we should be advocating improving our stamps for our outcomes. Neat. Good. The only way we can do that as some health, pulling out what clinical outcomes and how we're gonna measure those and basic jet.
Karen: 11:50 Yeah. And how do your outcomes from clinic aligned with
Michelle: 11:54 your vision and your mission? Like what is the mission of your clinic and how do you, how do your outcomes revolve around that? The way our mission is about providing innovative, results-driven, physical therapy services for a community. And the way that we measure the outcomes is that our goal is to get, use the hashtag better, faster. So we're all about getting people better, more better, and doing it in the least number of visits we possibly can. Now it's interesting because there's many practices out there, and I'm often challenged by this and this is where I butt heads with media, other people in private practice and like, but we get paid per visit. Why would you want to see people enlist visits? And I've had some really fun heated debates with some colleagues and peers over this Mike. But if we can do it and least visits, isn't that the right thing to do?
Michelle: 12:45 And then doesn't then allow us to advocate and, and, and prove ourselves and our value. And they're like, what? How can you afford to do that? Because you're basically sacrificing money because you're going to do it and least visits. So it's been a fun debate to have because we've had it now for many years. And I think the ties of changing, because I've been now in a position to actually go to payers and insurance companies and actually hit the data and say, look, we are doing at least visits. So let's talk about how we do some cost sharings. Let's talk about different ways to reimburse because we're doing it and at least visits and uncles to go to the outcomes to show that we're getting people just as bitter or more. That's really poor English with that. So I came up here. Yeah, that's okay. We get the gist of it.
Michelle: 13:35 So one of your outcome measures might be how many visits are in an episode of care? So we had the keys that we use, we use visits in an episode of care and the other one we use is the clinical more clinical um, change. So traditionally we've used photo focused on therapeutic outcomes of your system. Um, which has been great because that will, that will differentiate patients based on payer, um, diagnosis, body part, all of these things. So we can say, Hey, for a bag spine or all the Pedic on Euro or upper extremity, here's how, here's the change that we're getting in function and we can actually beat back and compare ourselves to other practices both in our region and nationally as well. You can do, it's an interesting time because now with MIPS and again I realized the assaults and people out there who don't know if MIPS are going to happen and we still don't have a lot of final rules, but again, we're still in with Mets. We're still using different, um, standardized clinical outcome tools that we're all very familiar with and I'm looking at opportunities to benchmark not just against it within their own practices, but between each other's practices as well.
Karen: 14:54 Yeah, I think that's great. I love looking at it that way of, of figuring out your mission and then how are you going to measure it and then taking those measurements and using it for a whole bunch of different things.
Michelle: 15:07 Well, I think that to me that's been the most interesting thing in our practice. It's, we've got this mission and a vision, which is what you have to start with. And your purpose. We've created the tools to measure it well. We've figured out what tools and how to measure it and it's, it's really helped evolve the culture of that practice. It's helped us with how we onboard our staff. It's helped us with how we recruit new people. It's helped us when we take on students. So it's had a big impact on every part of their practice. And, um, rather than just, you know, how just rather than just how we treat a patient, an everything embodied bodied, everything.
Karen: 15:47 That's awesome. And now you had mentioned photo and coming up in October, October 23rd to the 25th, and Knoxville, Tennessee is the outcomes summit. Uh, and you are one of the keynote speakers. So can you give us just a little sneak peek, a little taste of what your keynote speech is going to be about?
Michelle: 16:07 Well, so the keynote speak is all about on marketing with outcomes data, helping people understand the value, um, for outcomes data. When marketing your practice, I'll use my personal story because I think it helps to show that I'm, you know, really at the end of the day, just a little farm girl from a very remote part of the world. And um, so if, if I can use data to Mark it with anybody can, and I also like to talk a lot about the fear because I think there's a lot of fear out there. PTs are often scared. One of my deck data doesn't show what I want it to show.
Karen: 16:44 Right? Then what happens
Michelle: 16:46 then what happens? So yeah, that's like the million dollar question. And then what happens is people run away from fear and then they don't do it and so they're not moving forward. So I definitely had plenty of fears when I first started put up though the date and say what a for not as good as we think we are. Well, I find it interesting that it's really abandoned teach and if you're following what your purpose and your mission is and the results are going to happen because this changes all of the messaging and it impacts your entire culture. But I think it's a journey of how to address the fear of what if my data isn't as good as what I think it can be. Because when it comes to marketing, yeah, I can have beautiful brushers and amazing weird site. I can be open all different hours and think those things are going to differentiate me and they will a little bit.
Michelle: 17:37 But at the end of the day, I do think it comes back to data is the real differentiator and if you want to get serious about marketing and messaging what your practice does, and I think this goes, now I'm going to get on a, and this goes for our app proficiency as a whole and list were privy. At least we're proving that we really are the base caregivers for muscular skeletal and your a muscular disorders and diseases. Then we, you know, we're still lists, we're just not doing a good job, but at the moment like how do we differentiate ourselves from the other healthcare providers and fitness people out there who also say we'll take care of someone's back pain or help them get trained for a five K. so again, we have to, as a profession, as a whole, use that data and be comfortable using it to prove proven value.
Karen: 18:31 I love it and it sounds like it's going to be a great talk. So all of the people who are going to the outcomes, the clinical outcomes summit are in for real treat. Um, so that's awesome. Now, uh, before we, and here I have a one more question and that's what advice would you give to yourself as a new graduate? Fresh out of PT school. So that farm girl from New Zealand, she just graduated from PT school. What advice, knowing where you are now in your life and career, would you give yourself back then?
Michelle: 19:11 Oh my God, it's so much advice I would give. I think it would be about the key advice I would say is that your, we all have fear. We're all nervous of things. Whether it's, Oh, I'm going to make a mistake when I treat a patient or I'm going to have a practice that's not successful, or I'm going to open my mouth and sound like an idiot, but we're all gonna do it in. That's fine. And the only way to conquer those fears is just push through it and just keep, keep moving forward. So I think it would just be letting myself know at that shy Tinder age in my early twenties that, um, all the challenges that I had, just the same of everyone else's. And so yeah, just put on your big girl panties. They would say base the fears and move forward. Sorry.
Karen: 19:57 Great advice. And now where can people find you, whether it be on social media and or your clinic?
Michelle: 20:04 Um, so we have a multi clinic practice based out of Rhode Island with some clinics in Massachusetts as well. So performance ptri.com is our website and all their social media handles all reflect their performance. ptr.com P t@ptri.com. So, um, feel free to check out her website and we are you on Instagram, Facebook, Twitter, all of those, all of those places.
Karen: 20:30 Awesome. Well, Michelle, thank you so much for coming back onto the podcast. I appreciate it. You gave me a lot to think about, so thanks so much. Thanks very much, Karen and everyone, thanks so much for tuning in. Have a great couple of days and stay healthy, wealthy, and smart.
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