Pertelle's mission: outcomes

LAKE FOREST, Calif. - Known around Apria Healthcare as the "outcomes guru," Vernon Pertelle is leading the charge toward an industry wide outcomes initiative designed to bring credibility and respect to the HME industry. If successful, the HME industry will have undeniably valid data to present to CMS, commercial payers and legislators that clearly demonstrate home care's value in the healthcare continuum. The outcomes push has been plagued by fits and starts over the years as HME companies have resisted data pooling, and the industry as a whole has struggled with standardizing terminology. This latest effort is more critical than ever due to pending Medicare changes, and Pertelle minces no words about its urgency: "The time for inactivity has passed - we need to begin today." Pertelle, who serves as corporate director of respiratory and HME services for Apria, has crisscrossed the country to bring his outcomes message to industry groups. He has also spent the better part of a year writing a comprehensive outcomes guide with prominent respiratory specialist Joe Lewarski. It should be available in early 2006. Pertelle recently took some time to speak with HME News about his passion for the outcomes movement and offered some insight as to why it is so vital to HME's future. HME: You recently said that "HME is not considered to be part of the continuum of care" by CMS, Capitol Hill and perhaps the medical profession itself. How integral are outcomes to changing that perception? Pertelle: The United States spends about $1.7 trillion or almost 15% of the gross domestic product on health care. In 2002, Americans spent $5,267 per person on health care and from 2000 to 2005, the rise in healthcare costs alone is estimated to absorb an astounding 25% of the nation's projected economic growth. Some argue that the "fat" needs to be cut and the prime targets are areas where there is no clear demonstration of value. Although home care is a solution, the industry has not done a good job of demonstrating its value in the continuum of care. Developing an outcomes management program at the grassroots level allows us to begin to quantify the essential value we provide. Anecdotes, although true in many instances, won't change the negative perceptions of our industry; we must do a better job of quantifying data and documenting results in a compelling manner. HME: The outcomes movement has been around for a decade or so, but the HME industry can't seem to get off square one. What will it take to move forward in this area? Pertelle: We first and foremost must all speak the same language and understand the definition of outcomes before we begin to engage in an outcomes management program. Outcomes are measurable results of the processes used and decisions made in providing care. They encompass three areas: cost, clinical and patient satisfaction. During the past decade, healthcare outcomes and evidence-based medicine have had an impact on healthcare organization, financing and policy. They represent fundamental achievements that establish clinical medicine and assist policymakers with decisions regarding reimbursement. In today's era of the Medicare Modernization Act, many policymakers have demanded relevant data instead of anecdotes on the essential value of home care. For large, medium and small providers, the basic framework can assist in beginning to develop an outcomes management program like a patient satisfaction or outcomes questionnaire that is patient-centered. The questionnaire must encompass the aims, values and treatment effects prioritized by patients, and enable each patient to provide a satisfaction assessment. HME: How proficient are HME providers at collecting data that can be used for outcomes? Pertelle: I certainly cannot speak for all HME providers and the answer will vary based on the degree of importance assigned to this by the organization. Much of what we do today can be methodically compiled in an objective, uncompromising manner and reported to customers and policymakers at the grassroots level. Often times we can be just as effective in a one-on-one with our elected representative whose sole concern is the next election and meeting constituents' needs. There is power in data, and succinct summaries go a very long way in demonstrating our value. HME: What will it take to form a central repository for HME outcomes data so that the results represent the industry at large and aren't merely parochial to each company? Pertelle: Standardized terminology already exists. The source needs to be concise and compiled in a single tool for use by HMEs. A first step could be to hold a conference on the issue with proven experts to assist our industry in establishing standards regarding common terms and methodology. HME: Reluctance to share data and standardize terminology has always been blamed as an inhibitor. How does the industry overcome that reticence? Pertelle: Regarding sharing of data, successful practices are what should be shared - not the data. Statistical samples are necessary to prove a point in outcomes management, and statistical samples of our population of patients will be representative of the patients we serve. So in terms of specific data, we don't need to reveal all to demonstrate value. HME: What has the organization been doing with the data it gathers and is it taking a leadership role in unifying the industry on this issue? How so? Pertelle: Well, we certainly provide information to our customers on patient satisfaction and utilization trends. We have begun publishing evidence reviews on our CPAP clinic model, abstracts in peer review journals on our COPD management model and have developed a systematic process to quantify the results from our interventions using statistical samples. Much of the work published is objective, as data must represent the science regarding the interventions. AAHomecare is the conduit from which all efforts must be coordinated if we are to consistently forge forward in this effort. HME: You exude optimism that this movement can gain momentum and succeed at bringing the HME industry more credibility. What is the basis for that optimism? Pertelle: We've accomplished so much in the last year on quantifying the value of our services and providing that information to policymakers. Clearly the efforts over the last few years demonstrate our ability to collaborate on many fronts as an industry. We have begun to educate key members of Congress on our inherent value in the continuum of care. We have the opportunity to once and for all change the negative perceptions and begin to represent ourselves as professionals capable of developing the framework for programs involving outcome management at the grassroots level and ultimately as an industry.