Since PT treatment varies significantly by patient, condition, and provider, an appropriate cost benchmark should consider both the total cost of a PT episode and the average intensity of treatment, measured by the number of modules and the length of each session. Using two metrics to create an overall cost benchmark—based either on an episode or a set time period— would help to make the benchmark both more transparent and more achievable for providers.

By contrast, quality standards typically involve far more than two metrics. Often, these involve several of the six core aims for quality healthcare, as defined by the National Academy of Medicine: quality care should be safe, effective, patient-centered, timely, efficient, and equitable.


To be most effective, a PT payment innovation program should build its quality standard in two phases. The first phase should leverage available claims data to provide an initial view into patient outcomes without adding provider or patient burden. As conservative PT is a beneficial first-step treatment, service utilization patterns following PT reflect patient outcomes and care needs, and can conceivably measure the efficacy of treatment.

With that rationale, a program could track the following measures: the number of patients not requiring surgery following PT treatment; the percentage of patients seeking care from another provider for the same diagnosis following PT treatment; and average condition-specific costs within six months of PT completion. Tracking outcomes such as these can help align program expectations with realistic goals, and can also help distinguish outlier providers.

Incorporating patient-reported outcomes data
Although many experts argue that patient-reported outcome measures (PROMs) are the ultimate assessment of the efficacy of a given treatment, validated PROMs data is difficult to collect at scale. As compared to care processes, patient-reported outcomes are also far more sensitive to external factors outside of providers’ control, including variable patient expectations, lack of therapy adherence, behavioral choices, and social determinants of health that negatively impact the patient’s recovery.

Nonetheless, the second phase of quality standard development should incorporate clinical PROMs, which typically assess functional status, pain, and quality of life. Both the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons endorse several standard outcome assessments that measure these domains, including the Knee Injury and Osteoarthritis Outcome Score, the Oswestry Disability Index, and the PROMIS 10 global quality of life measure.

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