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All Airrosti providers adhere to disciplined clinical pathways that focus on quality and evidenced-based standardized processes. By implementing these standards, we have greatly reduced the variability in clinical practice and improved the outcomes for musculoskeletal conditions.
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Provider Expertise
- Provider Vetting and Hiring
- Candidates applying to become Airrosti providers must meet minimum provider prerequisites, subject to a CV filtering for interview selection. All Airrosti providers undergo a rigorous standardized interview process, thorough background checks, reference reviews, and education verification.
The final interview process includes, but is not limited to:
- Multiple group and individual interviews;
- Candidate presentation; and
- Minimum of two clinical practical exams- Mandatory Provider Training
- Before practicing, all Airrosti providers must complete 5-6 weeks minimum of intensive training at Airrosti's Clinical Development Center, including a Patient Clinic beginning the third week of training. Providers are routinely kept at the Clinical Development Center for extended training as deemed necessary. All trainees receive in-depth training on Airrosti's clinical pathways, as outlined below.
- Provider Oversight and Quality Assurance
- Routine reviews are conducted of all clinical outcomes, metrics, and patient satisfaction levels recorded within EMR during every patient visit. Airrosti's Clinical Development Team provides ongoing management and coaching based on individual provider metrics and to maintain quality assurance through the following processes and systems:
- Quarterly onsite clinical evaluations;
- Quarterly regional clinical round-tables;
- Clinical mentoring program based on provider metrics;
- Specific clinical coaching based on diagnosis-specific outcome reports;
- Review of patient satisfaction survey percentages on each provider; and
- Third party episodic claims analysisAdherence to Manual Medicine Guidelines for Musculoskeletal Injuries
- Evaluation and Assessment
- Providers obtain a detailed medical history of each patient (including mechanism of injury, symptoms, treatment to date, physical activities, past medical history, family history, and psychosocial factors that may delay recovery). A physical examination is conducted, noting: general appearance; vital signs; regional orthopedic and neurological examination; aberrant movement patterns; examination of related body parts; postural inspection, percussion, and palpation; gait analysis; and additional testing as indicated.
- Diagnosis
- Emphasis is placed on quality time with patient to perform a complete medical history, evaluation, and assessment that includes orthopedic, neurologic, motor, and functional/activity specific testing. The time spent with each patient is critical to rendering an accurate orthopedic diagnosis, potential differential diagnosis, and any possible contraindications.
- Documentation
- Detailed clinical documentation is an integral part of practice to ensure safe and effective care. Providers must adhere to HIPAA policies, guidelines, and security rules as it relates to all clinical documentation. These guidelines support employers, policy makers, managers, and clinical staff in documentation practices and policies that demonstrate the professional obligation, accountability, and legal requirements to communicate patient health information and clinical interventions in the public interest.
- Medical Necessity
- Determinations of medical necessity must reflect the effectiveness and cost-efficiency of patient care. Providers are required to closely monitor patient improvement and adherence to medical necessity through outcome data analysis and episodic claims review. Treatment is only prescribed when a significant therapeutic improvement over a clearly defined period of time is present.
- Conservative Decision Making for Imaging, Advanced Imaging, and Specialist Referrals
- Testing is performed with best clinical judgment to establish or support the diagnosis or for the necessary treatment of the patient. MRI, CT, X-ray, or other diagnostic studies may be performed if patient fails to respond in 4 weeks or experiences a significant increase in symptoms or impairment. All decisions are based on documented clinical guideline contraindications.
- Manual Therapy/Myofascial Release
- Soft tissue and joint mobilization is delivered through a hands-on approach (manual therapy), using skilled manual/physical medicine to effect changes in the soft tissues (including muscles, connective tissue as well as fascial tissue, and joint structures) with the purpose of improving function and range of motion.
- Active Care
- Active care includes methods of treatment requiring active involvement, participation and responsibility on the part of the patient. Individualized active care will be supervised in office, and the patient will be provided with instructions for home self-care. Active care in each phase of treatment begins when, in the treating provider's judgment, it is appropriate to do so. This would be based upon, among other things, the severity of the injury, the injured area, the patient's age, and other limiting factors.
A gradual increase in time per session, amount, and intensity of exercises will occur as the patient demonstrates improvement. Likewise, a reduction, modification, or discontinuation of the exercise program will take place if peripheralization (spread of symptoms) occurs.
- Patient Education
- All patients are fully educated on their diagnosis and treatment options. Providers clarify reasonable expectations for the resolution of symptoms and return to work or other activities. Providers are required to document all aspects of active care within the EMR (progress and restrictions).
Self-care is reinforced with patient through a HIPAA compliant patient education portal, with specific provider-prescribed instruction and exercises (video and pdf).
- Post-Treatment Functional Testing on Every Patient Visit
- Post-treatment functional testing determines improvement and treatment planning, which is based on medical necessity versus health plan benefit/visit limits. Such testing is also used to aid decision making regarding specialist or imaging referrals. Further visits require demonstrable improvement with post-treatment functional testing.
- Case Management/Treatment Planning
- Treatment plans always include quantifiable, attainable short-term and long- term goals, and documented progress toward significant functional gains and/or improved activity tolerances. If a contraindication or medical red flag is present, patient will be referred to the proper specialist. Treatment planning is prescribed solely on an outcome basis, not by benefit design or allowable visits.
- Differential Diagnosis
- Based on clinical findings, differential diagnosis is determined when two or more conditions with similar symptoms to the chief complaint are present. The provider will perform a systematic comparison and contrasting of the clinical findings.
- Contraindications
- Prior to treatment, the patient is evaluated for any underlying conditions that, based on the provider's licensure, experience and expertise, would modify or contradict the procedure. Contraindication or modification of procedures include, but are not limited to, the following:
- Severe Sprain/Strains: Due to severe instability. The patient should be referred for surgical evaluation, if indicated. Areas of adjacent fixation that are contributing to the instability may be manipulated.
- Rheumatoid or Psoriatic Arthritis: Due to potential ligament rupture or instability (i.e., transverse ligament instability), forceful manipulation is contraindicated. Use of soft tissue and mobilization techniques with light manipulation may be appropriate.
- Serious Vascular Disease: History or evaluation of serious vascular disease, including, but not limited to, vertebral artery dissection, vertebral basilar insufficiency, aneurysm, stroke, use of blood thinning medications, or clotting disorders.
- Musculoskeletal Disorders: History or evaluation of some serious musculoskeletal conditions may require modification or contraindication of some manipulative techniques. These may include, but are not limited to, fracture of the involved area, complete ruptures or tears, severe arthritic disease, or metabolic disease.
- Review of Current Research and Evidence-Based Practice
- Clinical directors engage in ongoing systematic review of the evidence supporting the diagnosis and treatment planning for a condition by clinicians and patients. When new guidelines and evidence emerge that improve quality and/or results, the clinical team incorporates appropriate clinical guideline changes.
Evidence-based clinical changes are systematically applied to the entire provider group through one or more of the following measures:
- Regional clinical roundtables
- Individual provider coaching
- Quarterly onsite clinical evaluations
- Provider required annual clinical meeting
- Outcome Measurement and Reporting
- Providers are required to obtain outcome measurements during every patient visit and record within EMR. This requirement provides real-time reporting on patient results, cost efficiency, and ROI relative to actual episodic claims data. Episodic claims analyses are routinely performed to validate that outcome-based care is both effective and efficient.
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