Improving Operational Efficiency, Effectiveness, and Value in Acute Care Physical Therapy Using the Therapy Value Quotient

Abstract

Background and Purpose: The shift in health care is toward value. However, operational efficiency measurement remains volume driven. Using behavioral economic heuristic theories and the Therapy Value Quotient (TVQ) as a basis for decision-making, the authors hypothesized that clinicians would demonstrate more effective and efficient clinical outcomes compared with the control group outcomes using traditional productivity decision-making heuristics. Methods: A quasiexperimental study design with quantitative analysis using the TVQ calculator was used. Also, an anonymous questionnaire on perceived decision-making empowerment and a semistructured focus group discussion with qualitative thematic analysis was used to understand better the heuristic strategies employed while trying to improve the TVQ Value Quotient. Results: Overall, the Value Quotient increased 14.7% resulting from a multitude of subcomponent improvements including increasing Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF) average change 28% from 2.84 to 3.64 points and decreasing Cost per Visit 8.9%. In addition, TVQ use improved clinician value focus, engagement, and perceived empowerment as evidenced by the 5 identified themes: (1) improved efficiency and staffing, (2) improved teamwork, (3) improved focus on value and not units, (4) improved patient-centeredness, and (5) professional empowerment. Discussion: Pursuing the simplicity of basic value-focused goals using the TVQ along with fast and frugal System 1 heuristics was more efficient and provided higher aggregated value compared with baseline management practice of units (Visits, Current Procedural Terminology codes, Relative Value Units) generated per hour. Furthermore, using the TVQ facilitated a paradigm shift from typical acquisition of units per hour worked to promoting an emphasis on delivering the highest overall value. The authors recommend acute care hospitals adopt the TVQ as a primary operational measurement to promote the highest value utilization of acute care physical therapy resources.