A Single-Number Value Metric Integrating Quality and Cost in Outpatient Physical Therapy.

IMPORTANCE

As health care transitions toward value-based care, outpatient physical therapy lacks a practical metric that objectively integrates quality of care and cost into a single measure of clinical value.

OBJECTIVE

The objective was to develop a single-number value metric (VM) integrating clinical effectiveness, patient experience, and cost efficiency in outpatient physical therapy and to determine its concordance with blinded manager assessments of therapist value.

DESIGN

This was a retrospective observational cohort study.

SETTING

The study was conducted at 8 outpatient physical therapy clinics within a single health care system, including freestanding ambulatory clinics and hospital-based outpatient departments.

PARTICIPANTS

The study included twelve licensed physical therapists and 2400 outpatient episodes of care.

INTERVENTION(S) OR EXPOSURE(S): Therapist-level patient-reported outcome measure (PROM) improvement, clinic-level Net Promoter Score (NPS), and financial data were combined to calculate a single-number VM. Blinded clinical managers independently ranked therapists according to perceived value.

MAIN OUTCOME(S) AND MEASURE(S): VM scores were calculated for each therapist. Concordance between VM rankings and blinded manager rankings was assessed using Spearman rank correlation coefficient.

RESULTS

VM scores ranged from 1.39 to 4.76 (median = 2.39; interquartile range = 1.99-3.13). Across 2400 episodes of care, 72.8% of PROM changes met or exceeded published minimal clinically important difference thresholds. Among ambulatory therapists, VM rankings demonstrated a strong inverse correlation with manager rankings (Spearman ρ = -0.82). Among hospital-based therapists, VM rankings demonstrated perfect inverse agreement with manager rankings (Spearman ρ = -1.00).

CONCLUSIONS

The proposed VM integrates clinical effectiveness, patient experience, and cost efficiency into a feasible, single-number measure of value in outpatient physical therapy. VM scores were strongly aligned with blinded managerial assessments of therapist value.

RELEVANCE: The VM offers a potential framework for evaluating clinical value in outpatient physical therapy and supporting the transition from volume-based to value-based care.