Development of Clinic Specific Physical Therapy Efficiency Targets Based on Clinic Specific Metrics

This study proposes an alternate model of developing physical therapy clinic efficiency targets within the Army healthcare system. Methods: The Military Health System Management and Analysis Reporting Tool (M2) and the Expense Assignment System (EAS IV) were queried to obtain fiscal year 2005 data from 28 military treatment facilities (MTFs). Ten variables entered a multiple regression modeling process to determine which variables, if any, best predicted total relative value units (RVU) for each parent MTF. Predicted total RVUs were entered into the Performance Based Adjustment Model (PBAM) to calculate the efficiency rating of each parent MTF. Results: Multiple regression modeling identified several useful models for RVU prediction. Both a monthly and an annual model identified four predictors of RVU production: 1) encounters performed by physical therapists, 2) encounters performed by technicians, 3) physical therapist clinically available FTEs and 4) is the MTF a Medical Center. The monthly prediction model for RVUs resulted in an adjusted R2 = .943 (p<.001). The annual prediction model for RVUs resulted in an adjusted R2 = .963 (p<.001). Conclusion: The current MEDCOM method of developing an efficiency target based on averaging is not appropriate. The distribution of the individual MTF's values is not normal and use of a measure of central tendency will always result in clinics above and below the target. Additionally, the current method results in several clinics with unrealistic efficiency ratings in the PBAM model which inflates the monetary budget adjustment for the MTF under the orthopedic product line. Developing individual clinic targets for each MTF with a regression model develops achievable targets for every MTF based on the characteristics of the clinic and reduces the wide variation in PBAM efficiency ratings and resulting monetary budget adjustments.