When Apple found itself behind, Steve Jobs would innovate his way out of the problem. The best known example of this is finding that the original iMac, great for creatives and photo handling, wasn’t any good at music… it didn’t even have a CD burner! Apple was getting trounced by PCs in this area. Apple not only gained ground, but leaped ahead by creating iTunes and the iPod. These products literally restructured the entire music industry for everyone but Garth Brooks and a few other holdouts.

Last week as I was pondering this week’s post I thought to myself … ‘Self, how are you going to turn this obviously tech related, innovative ‘leadership lesson’ into something that has utility in the private practice physical therapy world? I was stumped.

Then I read a fascinating article in HBR by business strategy icon Michael Porter and Thomas Lee titled ‘The Strategy That Will Fix Health Care - Providers must lead the way in making value the overarching goal.’ You can find the abstract here and I recommend buying the article. Everybody in the the US healthcare chain should be forced to read it.

” At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost”

Here’s the gist: Providers (OK so he really means hospital systems and physicians) need to do 6 things all at once to fix America’s ailing healthcare system.

1. Organize into Integrated Practice Units (IPUs).
2. Measure outcomes and costs for every patient.
3. Move to bundled payments for care cycles.
4. Integrate care delivery across separate facilities.
5. Expand excellent services across Geography.
6. Build and enabling information technology platform.

What struck me when reading this is that we are already behind! Dr. Porter did bring us up a few times as excellent examples of how we can save costs and how utilization of ancillary providers (like PTs and nurse practicioners) creates efficiency and cost savings. For example, we are < 1/4 the cost of a physician visit and there is plenty of evidence to show we can save downstream costs. As a profession, this single article may do more for us in terms of positioning us as a part of the solution than anything else I’ve seen to date. However - it was always in the context of the PT in the medical center.

This model would create Integrated practice units, which PTs are certainly a part of and have a role in. IPUs are like a next generation Center of Excellence focused on being the best at one diagnosis or patient type. These already exist - the example Dr. Porter uses is Virginia Mason Medical Center in Seattle - which focuses on treating low back pain. After calling a single number, patients are scheduled to visit a PT and later that day a PM&R physician (just in case?). If the patient needs anything other than PT then they can receive it right there in the same hospital. In the IPU strategy the expected outcome is that IPUs become bright spots in care delivery for particular diagnoses. Employers and health systems are then to be encouraged to send exclusively to them to handle the entire course of care… including rehabilitation. So how then do they take care of the outpatient PT piece? Answer: they ‘expand excellent services across geography’. Ouch.

“Organizations that progress rapidly in adopting the value agenda will reap huge benefits, even if regulatory change is slow.” (Porter and Lee)

So how do we leapfrog ahead of this (admittedly brilliant and needed) strategy to ensure that private practice physical therapists have a place in this New HealthCare World Order. More to the point - how to we do that in whatever less well thought-out version we end up with? Do we all have to go work for the hospital? I think there are two ways we lead our organizations to get there:

First - measure outcomes. Our company uses FOTO to measure functional outcomes on every patient. This is the first step in participating in the new healthcare world. We have to be able to achieve and demonstrate a high level of value for our patients and ‘what gets measured gets managed’ (Peter Drucker). If we don’t measure it - how do we know how much value we are adding? How can we improve?

Second, we have to be ahead of the need for efficiency. We need to figure out the innovative care models that stretches the PT’s capacity to see more patients effectively in a day. The days of 1 PT caring for 1 Patient for 1 hour are gone… to the same place that the family practice physician visiting your home went.

Where we will continue to have demand for our services is in our ability to be where our patients live, play and work. People will go across town to see a specialist. If they work for Wal-Mart and a few other enterprising companies they will travel, expenses paid, across the country to get a new hip. However - what they can’t or won’t do is travel any real distance to attend physical therapy sessions. IPUs will have to figure out how to provide high quality rehabilitation to remote patients. That isn’t the clinics owned by physicians (POPTS) or hospitals (HOPTS) - that’s us.

IPUs face the challenge of trying to be good at all aspects of care delivery for a given condition. High quality physical therapy providers who measure outcomes and have some geographic spread away from the IPUs can leapfrog ahead by being ready to participate in these IPUs. Perhaps we can participate as partners through hospital contracts or at minimum by being a provider of choice for the IPUs, who by definition care about outcomes enough to care about the value we provide.

What that means is that your practice will probably be judged in part on your therapist’s ability to communicate back to a coordinating physical therapist at the IPU. Think this isn’t already happening? We regularly see patients from the Andrews Institute in Florida (our practice is in Texas). Why? Because this high quality orthopedic practice, which receives patients mostly from domestic medical tourism, knows that we use their protocols and are open to discussing cases with the therapist that sees the patients on follow up. Some good outcomes on initial cases have earned us preferred provider status and they typically call us about patients even before the patients call to schedule.

Steve Jobs was a master at innovation and leapfrogging over Apple’s competition. We can do the same thing by focusing on what will be important in the New HealthCare World Order. That is likely to be the best outcomes with the lowest cost.