Why Am I Doing FOTO
• Eminently qualified to discuss every sort
of practice problem !
– Including implementing FOTO
• Working on solutions all the time !!
– FOTO has been – continues to be – a
solution for me
“Making good judgments when
one has complete data, facts,
and knowledge is not
leadership - it‟s bookkeeping.”
“Birth of the Chaordic Age”
•Information = societal Diversity X societal Complexity2
•In 20 years we have
•1000X better algorithms
•500,000X more computing capacity / individual
•500,000,000X more mobility of information
•The world (and FOTO) has the capacity to:
•Receive, store, transform, and transmit information
•Only YOU can choose to utilize it or not.
•FOTO began and must continue to evolve
•I need the information
•I need and want it faster
•I need and want it simpler
•I need and want it more complex
•I need and want it all and we want it now for each patient episode!!
•I must change..I must not perpetuate old ways, but seek new ways, and
no one will ask my consent…it‟s an information revolution that is part
of a natural evolution.
Did I believe I needed this information?
• Why am I a part of FOTO?
• Why am I making my therapists deal with this extra paper work?
• What good are the indexes?
– Did I know?, Could I explain them? Could I use them?
• Every therapist has a 90+% pt satisfaction..so? Anyone at 100%? I
have a therapist at 99.27%!
• I had to sell myself, I am the FOTO Champion on the value added
to my Facility/Co?
• If you show one tiny flaw in your belief the entire process is
subject to failure from your lack of total commitment.
You must choose to LEAD the FOTO parade!
Why the need and want of
For me it was to embrace change
in my practice so I could help
people improve the quality of
The one constant is change
So what do we do with all this information?
• We challenge ourselves to manage our
practices with it
• We use it to make ourselves better
• We tame it by admitting our mistakes
– Mistakes are toothless little things if you
recognize and correct them. If you ignore
them, they grow fangs and bite!
Therapists choose where to be led
• In a very real sense, followers lead by
choosing where to be led
• Will they believe the #s?
• It is simply raw data until it is used
– to induce a new way of practicing into the
• who will then choose to change,
• choose to improve,
• choose to learn more,
• choose to manage self.
• The patient must understand the reason they were
sent to PT! So…I have to tell them!
• I have to help them understanding their goals,
their part in the rehab process to attain them, and
that I am working for them and with their MD.
• Patients need to be sure they do not feel they‟re
wasting their time or their $$ - we both have so
little of either!
• FOTO assists me in understanding my patient!
Physical, mental status, social skills, etc.
• We choose to follow
• Choice is essential.
• I used to Gather info…
– count what I did to pts i.e.
– # US, Ther Ex, ES, gait training,.. And counted $$
• Why was I doing it? Did it help me in any way ?
• Was the patient cured? How could I know?
• I wanted a better way to count ,to measure my
• FOTO helped me once I chose to follow their lead!
Would I get good Outcomes?
I found out early not to be afraid!
FOTO is the patient‟s perception of the care
they are receiving.
Patients will evaluate me as I evaluate them!
That‟s fair and good!
The Patient Leads
• 50% of the time I should manage myself
• 25% of the time I should manage my
superior ( the pt as boss delight them!)
• 20% of the time I should manage my
• 5% of the time I should manage those
over whom I have authority.
FOTO helps answer Patient Centered
• Did patient complete their care or self discharge?
• Did patient feel as if they were helped?
• Did the patient feel supported & cared for?
• Were the goals I set for the patient met?
• What did the predictor/trend report tell you
about the patient?
• What did you learn?
T.S. Elliot said
• We will “come full circle to the place from
which we set out and see it for the first time.”
• What would I find on this FOTO journey?
• Would knowledge, rapport, science, believing
be important.. count me in or out ?
• Where would I go if I found out…full circle?
• Would my eyes see and ears hear the truth
from my patients…Would it hurt?
• FOTO gives me information
• I choose to utilize it in ways I will share
with you today.
It Never Ends
• Early problems will occur
• Give it a year –
– FOTO is a rolling year
• Familiarize yourself
• Quarter End Edit reports tell you what‟s
• What Quarter End Edit Report? Find it!
• We know we are good do not need FOTO
• This information they ask patients is
confidential! Pts won‟t share!
• FOTO is not valid or reliable
• Too much time and $$
• Way too much paperwork
• These #‟s have to be wrong my pts are
sicker than these reports show…..oh my!
Barriers will go away
• I want a shoulder course my OI is too low!
• Patients think it is good we ask how they feel
about the care!
• FOTO is valid and reliable ask Dennis!
• Cadi software is free and what a timesaver
• Risk adjustment gives me great look at my
patients severity. I‟m not good with the elderly
• 3 T‟s at TTC Teach, Train, Test…
• Teach why and what
• Train how …Judy Judy Judy..trains you!
• Test results with FOTO reports…
• Then learn…and lead to new levels by
……re..teaching, training, testing
• Training with the Why! The Y is what it
takes to make FOTO Y…ours!
• How it helps therapists see themselves as
patients see them…rapport! Isn‟t caring
and the patient believing in you the real
cure? The best medicine??
Getting Buy In
• I had to reach agreement with each
therapist..eyeball to eyeball one on one
• What I wanted and needed meant little if
the therapist did not see the value and
buy into the plan and agree to participate
• Persuasion not compulsion was
• I ask Joy “How many new patients did
we see? Did we get them in FOTO?”
• Joy asks FD “How many new pts? How
many new did we get into FOTO ?”
• FD asks PM and Therapist “Did you get
your new pts into FOTO?”
• When #‟s are low helps to do this every
day builds habit!! On job training!
This question only gets stats!
• The other ?‟s
• Are you using the intake to write your fx goals?
• Are using fx expectations in POC?
• ARE YOU SHARING INFO WITH
• Linda G „s email to Katie D!
• Ken horrid FOTO my personal talk with him
It Never Ends
It‟s Managing with
Outcomes Evaluation Process
• Look at Group Roll-Up compared to Aggregate
• Look at each Facility compared to Aggregate
• Look at each Facility compared to Group
• Look at each Therapist compared to their
What do you see?
Where are the scores better? Where are the scores worse?
Managing With Outcomes
Analyzing the Outcomes Profile lets you:
• Manage Practice
• Manage Individual Facilities
• Manage Therapists
Facility to FOTO
• I look at each facility compared to the
nation…… and ask:
– Does this facility measure up?
– Why not, what am I willing to do about it?
• If scores are low
– Train? CE course?
TTC Facility to Facility
• Each office gets an opportunity to see how they
stack up to each other
– Competition is good!!
• Ideas percolate as they try to improve
– Signs about FOTO show up
• People start to ask “did you get a FOTO on
• If I see a trend that is bad – I take real action
– On the yearly eval
– One on one meetings
– Involve everyone
• Compare All Offices Over Time
• Look at OI by Impairment Category
compared to Overall
• Look at OI by Therapist Over Time
• Compare Medic (real) number of Intakes
to number in FOTO (for efficiency and
effectiveness) by Facility and Therapist
Start over and over???
If OI is low
• ask ?
– New Staff? Hurts Fac #‟s
– Staff changes FD,PM,PT?? Hurts Fac #‟s
– Lose trained staff? Hurts Fac #‟s
– Computer down? Hurts Fac #‟s
– CADI down? Hurts Fac #‟s
– Network down? Hurts Fac #‟s
– ASK? ASK? ASK????????!!!!
• Praise and lots of it to all teammates
• Use as mentors to teach..
• Share their process to help others not
doing as well
• Heaven or Hell (joke)
• Future to reward with $$
Therapist Issues to Manage
• Are my therapists participating? Medic to
FOTO data - we set benchmarks
• Improving overall and by impairments
• How‟s the Quality within the practice?
• Our QA…with FOTO
• Are they using the Predictor report, trend
– Katie on POC‟s and DC summaries
Quality Can not wait
Concurrent QA audit on cases where the pt has 3
visits over the predicted at intake
ASK WHY case is over helps thinking!
Is it appropriate or not?..Action
We are trying to manage cases as we go not just
retrospectively when an ADR appears
• If I find the personal OI is so bad this
quarter I ask FOTO for special report…
• FX scale report to see the rest of the
story ..breaks it out in detail .(this PM)
• If Satisfaction is below the FOTO mean
(I freak) then ask for special report…
• I get a PT satisfaction report (this PM)
Stuff to never forget
• Rolling 12 months of data
• Edits help see our mistakes …give them
• ASK if therapists got their report
• Ask what they see in the report
• Ask about plans to change
• USE the data all the time
• by email, by phone, by fax, by carrier pigeon,
or smoke signals but talk about the good and
bad parts of FOTO out loud and clearly!!
• I always find something good to say
• “Proud your getting cases into FOTO”
• Talk the walk it makes the journey enjoyable I
really like my staff and I want them all to do
• I tried to induce not compel change.
Manage with the data
• Share the data
• Ask Questions! Seek answers!
Can very severe pts get better with therapy?
# of pts 146 17,881
OI 159.24 111.35
What about slight?
#pts 163 17,480
OI 37.20 23.23
My reporting needs were
beyond what FOTO gave me
• I needed to see all the therapists side by
side..who could mentor?
• Facilities side by side ..who‟s best?
• Therapist alone over time improving?
• Facility alone over time improving?
• Co improving?
• Compare all to each other ,to TTC,and to
• She took the reports and reformatted in
an excel spread sheet and saved me hours
of hand work!!
• She keeps it up quarter after quarter!
• You may need a TRISH!!!
FOTO is Everywhere
• Bottom of the Co ,Facility, Individual PT
• “Money motivates neither the best people nor
the best in people. It can move the body and
influence the mind, but it cannot touch the
heart or move the spirit.”
• FOTO means Quality as felt by the Patient
• Very important!
• Therapist Evaluations..
– yuck in past …didn‟t do
• Too subjective if objective too easy to loose a
• now I feel Yearly, ¼ ly, 3R eval form
– (see hand out) objective and helpful!!
• Are Done one to one gives everyone an
opportunity to focus on what we all believe is
critical to our success..
– FOTO is there!!
FOTO, It makes You Crazy
cares how much you know
until they know how much you care.
• Keith Kleven said
– He treats celebrities
– I admire Keith and share this philosophy
Leadership is the act of
accomplishing more than the
science of management says is
Will and Grace
• With the will to succeed and the grace to
compromise, all things become possible.
• Who do you need? Will or Grace?
• I needed both…
– FOTO on therapist annual
– QA compromise not 3 over or under, just over
(for now anyway!)
• Both Confident and Modest
• Authentic walk the walk.. not just talk
• Listeners.. because they are curious not grandiose
• Good encouragers and are never satisfied
• Make unexpected connections
• Provide direction not answers
• Not in control not really in charge - are in touch
and out in front
• Protect people from danger and expose them to
• Make change and stand for values that
do not change..expendable /precious
• Lead by example
• Do not blame, they learn..
• Today fellow leaders learn all you can
& Managing With Data
Use up the speakers with every question
you have so you can return and lead
your facility to better outcomes…Our
Profession needs you!