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November 28, 2012 | Tom Ballard

Ben Johnston was an early believer in measurements and outcomes

(EDITOR’S NOTE: This is the second in a two-part series about local business executive and entrepreneur Ben Johnston.)

Knoxville resident Ben Johnston has spent the last 20 years focused on measurements and outcomes for the physical therapy profession. With a new rule that the Centers for Medicare and Medicaid Services (CMS) has approved starting January 1, those two decades of work are likely to produce big dividends for his North Knoxville company called Focus on Therapeutic Outcomes or FOTO, Inc.

Johnston told in a recent interview that CMS is requiring all outpatient physical therapists (PTs) to submit what he called a “functional measure” if they want to be reimbursed by Medicare.

For Johnston, it’s “music to his ears” after a lifetime of work as a physical therapist, teacher and consultant who has a passion for documenting the impact that therapists have on their patients. For FOTO, the company that he and business partner Al Amato run, it’s validation of a business concept that they launched in the early 1990s.

At the time, Johnston was Senior Vice President of Rehab Clinics for a Philadelphia company who had convinced the company’s President to allow him to pursue his vision of measuring the outcome that a PT achieves.

“I reached out to five other competitors to see if they would share data,” Johnston said, adding that the initial “big hurdle” for the five competitors was answering the question, “Why are we sitting at the same table?” They found their answer and agreed to focus on pre- and post-treatment in three areas – knee, lower back, and neck.

“We came-up with a patient questionnaire asking how well a patient can perform a function,” Johnston said. There were 50 questions for each of the three areas.

“We were able to identify the average change by clinic and therapist,” he added.

The not-for-profit coalition gave way to the for-profit company called FOTO when it  was sold to Al Amato. With the Rehab Clinics company now in the hands of others, Johnston retired and moved back to Knoxville. The detachment from FOTO did not last long.

Johnston said that he was contacted by Amato who wanted his help.

“I told him that I’m not going to travel, and it (FOTO) has to be in Knoxville,” he explained. They quickly agreed, and they began their partnership.

Johnston said their first task was to simplify the survey process.

“We needed to get enough information without overburdening the clinical process,” he said. The simplification efforts gradually migrated to the use of computers, computer-assisted testing (CAT) and, by employing a technique called “item response theory.” They reduced the questions asked of the patient from 50 to five by establishing a list of functional activities, which they developed into a “hierarchy of difficulty for each major joint in the body”

“We were able to be 97 per cent as accurate with five questions as if they (the patient) had taken all 50,” Johnston said.

FOTO also converted its assessment tool to a web application to collect patient data before the initial office visit with a physical therapist and to allow FOTO to collect data in the event that a patient did not complete all treatments.

Today, FOTO has 4.7 million “patient episodes” in its database. The information can be used in a variety of ways – from the reporting that CMS is requiring to a marketing tool that individual PTs can use to document their results in specific treatment areas like knees, lower back and necks. There is also a direct benefit to patients.

“Using 10 risk-adjusted parameters, we can access the database and come-up with 7,000 people with similar situations,” Johnston said, explaining that the database can be sliced by age, pain levels, and a variety of demographic factors. “It allows the therapist to communicate directly with the patient about what will happen and how many treatments are likely.”

Johnston describes it as “managing outcomes at the bedside” and says that “the hardest thing for a patient is understanding what they should expect.”

Nearly 50 years after earning his physical therapy degree and entering the profession, Johnston is clearly excited about the future. He believes that FOTO, which has 2,000 customers, “is looking for huge growth” as it raises capital to fund expansion.

For Johnston, it’s all about continuous improvement – in the services that PTs deliver, in the outcomes that they produce, and in the way that FOTO adds value. The CMS rule has resulted in FOTO splitting its outcomes product into two pieces – a survey instrument, which is required to meet the upcoming CMS requirement, and a reporting tool, for those who want to use the functional change they achieve for continued quality improvement and be part of the national benchmarking and data comparison database.

As far as ease of use by patients, Johnston says, “I envision an app for the smart phone to take a survey to see if you need to see a therapist.”

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