Ever since Cleveland Clinic rolled out its 6 Clicks functional measurement tool in 2011-2012, Mary Stilphen, PT, DPT, has been scrambling to keep up with all the invitations she receives to speak about it.
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“I’ve presented on 6 Clicks to the American Hospital Association, the American Physical Therapy Association, the American Medical Rehabilitation Providers Association and a host of regional organizations,” says Stilphen, Senior Director of Rehabilitation and Sports Therapy at Cleveland Clinic and a leader of the 6 Clicks initiative.
“There’s a lot of interest in how we’re using this tool at Cleveland Clinic to promote a culture of mobility, reduce inappropriate referrals for therapy and optimize post-acute discharge planning,” adds Stilphen, shown above at a 2016 speaking engagement.
6 Clicks in brief
6 Clicks has been covered on Consult QD before, from the standpoint of validation studies confirming its accuracy and reliability and successful efforts to integrate it into Cleveland Clinic’s electronic medical record enterprisewide.
Briefly, the tool was developed at Cleveland Clinic as a short form of the AM-PAC™ (Activity Measure for Post Acute Care™) instrument developed by Boston University researchers. Designed to be minimally burdensome to both providers and patients, 6 Clicks is an electronically administered pair of questionnaires that assess — through six questions each — patients’ mobility and self-care abilities. Cleveland Clinic physical therapists (PTs) and occupational therapists (OTs) complete the tool at each evaluation of every hospitalized patient for whom a consult for PT/OT is requested by a physician.
The initial objectives were to determine appropriate referrals for PT/OT, guide discharge recommendations, and improve allocation of therapy resources and personnel in the acute care hospital. The tool has since been introduced in some skilled nursing facilities (SNFs) in Northeast Ohio to efficiently help SNF staff better monitor patients’ functional progress during their SNF stay.
What audiences want to know
Stilphen says that across her many speaking engagements about 6 Clicks — which has been licensed for use by numerous healthcare organizations across the country — audience interest tends to focus on the following three ways 6 Clicks is used:
1) To educate physicians about therapy referrals. “Our early use of 6 Clicks documented that our PTs and OTs were frequently being asked to consult on inpatients who were functionally independent and didn’t need PT or OT services,” says Stilphen. “We’ve since been able to use 6 Clicks data to show physicians throughout the organization that not all inpatients need the skills of a therapist and to teach physicians which patients are appropriate for therapy consults — and which ones aren’t.”
Stilphen continues to meet weekly with clinical areas throughout Cleveland Clinic to review their inpatients’ 6 Clicks scores and opportunities to make consult referrals ever more appropriate. “We’re using 6 Clicks to really focus our interventions on the right patients at the right time,” she says.
2) To drive value and system change. 6 Clicks is all about data: Meaningful discrete data are collected by therapists at every inpatient encounter and then used to drive clinical decisions, guide resource use in the hospital and help determine the most appropriate discharge disposition. The result has been collection of millions of data points on patients’ function, with approximately 68,000 inpatients evaluated via 6 Clicks in 2016 alone.
“Having data to show how we should be directing our resources has been invaluable — it really makes a difference in getting all hands on deck with these initiatives,” Stilphen says. Of course, avoiding consults for patients who don’t need them results in direct cost savings, and 6 Clicks’ broad promotion of a culture of mobility also fosters quality of care and associated cost savings “because patients don’t get so deconditioned while they’re in our care,” Stilphen explains. “Hospital leadership understands how this translates to value across the board, and that’s resulted in strong buy-in.”
3) To curb unneeded precertification requests. Recent interest has focused on one particular area of value: Using the 6 Clicks score to reduce inappropriate precertification requests for transfer to an SNF. This initiative stemmed from therapist perceptions that precertification requests were sometimes prompting unnecessary therapy visits and needlessly delaying SNF transfer and prolonging hospital stays — perceptions that were supported by disposition data.
In response, Stilphen and Department of Physical Medicine and Rehabilitation leadership developed an idea: Hospital patients with an initial 6 Clicks score of 18 or below (out of 24, which indicates maximal function) and for whom PT has recommended SNF transfer should not require an updated PT/OT note for admission to an SNF unless required by their insurance.
The idea was tested in a small pilot with one payer, which confirmed the concept: This approach was found to reduce requests for precertification visits, length of stay in both hospital and SNF, and administrative burden for all parties — hospital, SNF and payers. The concept has since been implemented across multiple Cleveland Clinic hospitals.
“We presented data to payers and convinced them to use our 6 Clicks-based approach in lieu of a precertification visit for selected transfers to an SNF,” Stilphen explains. “The aim is to get patients to the appropriate level of care as soon as they’re medically stable and avoid unnecessary precertification when patient status hasn’t changed. In the process, we believe it’s reducing costs significantly by avoiding prolonged hospital stays. We look forward to sharing more about this initiative’s impact on costs and outcomes in the future.”