Outcomes Manager/PPS Coordinator — Trisha Dorries

This week’s spotlight is on Trisha Dorries, MS, OTR/L, CLT, MBA, a Non-Clinical 101 graduate who is now Outcomes Manager/PPS Coordinator for LifePoint Health at Mercy Rehabilitation Hospital!

What is your full name, title, and company name for your current, primary role?

Trisha Dorries, MS, OTR/L, CLT, MBA — Outcomes Manager/PPS Coordinator for LifePoint Health at Mercy Rehabilitation Hospital in St. Louis

What additional roles do you currently have?

I am currently a data analytics fellow for Bluebonnet Data.

Where are you located?

St. Louis, Missouri metropolitan area.

Where did you go to OT school, and what year did you graduate?

Washington University in St. Louis, 1996.

What did you do when you first finished school, and for how long?

I worked in a smaller hospital, OSF St. Joseph’s in Bloomington, IL. I worked there for about 10 months before moving back to the St. Louis area. Then, I worked at SSM Rehab at DePaul for about seven years.

In what setting(s) did you work, and what types of patients did you treat?

My first two positions were similar, in that all the OTs worked in all areas of the hospital:

• Acute care
• Subacute or hospital-based skilled nursing facility (SNF)
• Acute rehab
• Outpatient

In both hospitals, I treated adults with all kinds of diagnoses in acute care (but generally not major trauma). In my first position, I was also able to do more outpatient therapy and even treat some hand patients and industrial rehab. In my second position, I was mostly in the acute rehab unit.

What did you enjoy about your early roles? What didn’t you enjoy?

I enjoyed working in the variety of settings and the creative problem-solving. I felt like I was able to learn and grow as a therapist. For example, figuring out how to modify something at home, so a bilateral amputee could successfully get on/off his toilet.

I also had great groups of therapists I worked with, who I am still friends with to this day.

I enjoyed my first two roles immensely until about five to six years in, when I felt like I was not growing as a therapist anymore. I attempted to move to a leadership role and was not chosen.

What else have you done since then, prior to your current outcomes manager role?

I worked in a variety of settings, including another hospital where I became lymphedema certified. I worked in outpatient in a few different roles: a small private clinic primarily treating lymphedema, outpatient neuro for a hospital-based clinic, and outpatient OT in an assisted living facility (ALF) where I was also the rehab director. I worked in home health a few different times as well.

When and why did you decide to do something non-clinical?

I decided several years ago (probably around 2013-2014) that I really wanted to transition to something non-clinical.

Initially, I thought that I would have an easier time transitioning to leadership. Yes, I’ve held a couple leadership positions, but I always continued treating as well. I eventually realized that I did not want to be a middle manager, at least not in healthcare.

In 2016, I started working with a career counselor. I tried to pivot out of direct patient care, but the contract company I was working for lost the contract in the building I was in (ALF). I needed to find a job, any job, and the job I found was my last clinical job—in home health.

Home health during COVID sealed my decision to get out of patient care. I was over-worked, under-appreciated, and paid by salary—so I was not compensated for my 50-60 hour work weeks. I also felt that, after 20+ years, I was burned out and experiencing caregiver fatigue.

What are you doing these days?

I am an outcomes manager (PPS coordinator) for an inpatient rehab facility. I am responsible for coordinating the information that goes on the Inpatient Rehab Facility Patient Assessment Instrument (IRF-PAI) that gets our facility reimbursed from CMS.

My facility is large, at least compared to others in our organization. There are two of us in this position, and there is some variation in the tasks we do compared to other inpatient rehab facilities. The IRF-PAI would be like the MDS in SNF and the OASIS in home health.

My position requires attention to detail, medical record reviewing, extensive knowledge of the GG codes (also referred to Quality Indicator (QI) scores), as well as the regulations around the entire IRF-PAI.

I run a daily QI huddle with therapy and nursing to discuss QI score discrepancies and missing information to get the most accurate information on admission. If there are significant discrepancies at discharge, we discuss those as well.

There are processes for admission and discharge for each patient admitted to the facility—regardless of their insurance. I also generate the Individualized Overall Plan of Care that the physiatrist needs to sign by the fourth day of admission, so either my co-worker or I have to work most holidays. We are also responsible for educating new staff in QI scoring and credentialing.

What are you doing outside of your outcomes manager/PPS coordinator role?

Until recently, I had a side business doing maintenance lymphedema massage for two clients monthly.

Over the years, I have also been a lab assistant at the Washington University PT school for the lymphedema section for a few sessions per year.

I recently started a 14-week data analytics fellowship with Bluebonnet Data, a political nonprofit organization.

Are you still treating patients, or are you solely non-clinical?

Since stopping my lymphedema side hustle recently, I am solely non-clinical.

How long have you been in your current role?

Since March 2021.

What do you wish you would’ve known before going into this outcomes manager role?

I wish I knew how challenging it can be to get the information I need. In my facility, the rehab documentation is in one system while the medical documentation is in another system. I think some of the challenges of my position would be less if there were only one documentation system.

Did you get any special certifications or training along the way to help you get into your current role?

I took the Non-Clinical 101 course!

I think the personality-type recommendations for positions (“Who It’s Great For”) in the Non-Clinical 101 Lookbook are particularly helpful in narrowing down the types of non-clinical careers that are a good fit.

In Non-Clinical 101, the career paths that are most closely related to Outcomes Manager/PPS Coordinator are Compliance & QAPI and Utilization Review.

I expected to become PPS certified within two years of starting my position, but I completed it in six months. This involved two courses through UDSMR that were paid for by my employer. The first was a PPS bootcamp, and the second was a PPS certification course. Then, I was required to pass a certification test through UDS. The certification is good for two years. I recently re-certified, which required a short review webinar and a test.

How did you find your job? Did you apply or find it through a connection?

I applied to my current position, but I think part of the reason I got it was because of a connection.

I originally saw the position on Indeed and spent a significant amount of time customizing my resume. I attempted to apply on the website (Kindred, at the time), but it appeared that the open position was no longer active by the time I was ready to apply (the same day). I was frustrated, but after doing all that work, I decided to go ahead and apply on Indeed.

I got a call from the HR director a few days later and had a screening interview and an in-person interview with the Director of Quality, who would be my initial boss, about one and a half weeks later. I thought that the interview went well, and she wanted a therapist, as the other outcomes manager is an RN. About a week later, I got an email from Indeed stating that I was not chosen for the position. I was disappointed, but I emailed the HR director, and she verified that I was still being considered for the position.

A side note is that a few years prior to applying and interviewing for this position, I did an informal interview with the HR director. I think that helped me get the position, as well as my previous inpatient rehab experience, my overall experience working in that building, and having a family member as a patient previously.

I think having history with the facility and the HR director helped me get this position.

Did you do anything special to your resume and cover letter to land the outcomes manager job?

I customized my resume by highlighting my previous inpatient rehab experience, including my time as a rehab coordinator. I highlighted my home health experience with GG codes and my leadership experience. I also mentioned in my cover letter that a family member had previously been a patient in that inpatient rehab facility.

What was the interview like for the outcomes manager role?

The interview was like a conversation but with the expected behavioral questions, such as, “Tell me about a time when you…”

I highlighted my therapy experience and how I would handle discrepancies in scoring. I also highlighted my experience as a rehab coordinator teaching FIM (now replaced with QI scores), discussing outcomes, etc.

How have people reacted to you leaving patient care?

When I initially talked about leaving patient care, my co-workers wondered why I wanted to and would generally compliment me on how well I helped my patients.

I think I would have had different reactions if I had transitioned to non-clinical in an organization I was already working for. Even though I had history with my current organization, I had not worked in that actual facility for several years.

What’s a typical day or week in the life like for you? What types of tasks and responsibilities fill your time?

I typically start my day by checking to see what information is not completed yet and making a list to give to department leaders (nursing, therapy, and pharmacy).

Then, I typically put together information for our QI (Quality Indicator) huddle with therapy and nursing to discuss discrepancies in scoring, prior level of function, and missing information. We project an Excel spreadsheet on a TV showing all patients who are day-three admissions, their likely diagnoses, and a rough idea of their CMG (which determines their length of stay).

Depending on the day of the week, I then work on IOPOCs (Individual Overall Plans of Care) to send to the physiatrist for signature by day four of admission. I also process admissions and discharges. When our information is completed for discharges, we email the HIM manager to finalize information and transmit to CMS.

Monthly, we teach a QI training class for new nursing employees (nurses and techs).

Every two years, the whole facility re-credentials in QI scoring. We are the point, with the nursing educator, to coordinate that for all nurses, techs, and therapists.

What are some of the rewards of your role? What are the biggest challenges?

One of the rewards is knowing that we are taking information about the whole patient (diagnosis, co-morbidities, prior level of function, functional tasks from self care to stairs, bowel and bladder continence, diet type, high-risk medications, and other special treatments) to determine their length of stay and the reimbursement the facility receives. Teaching and clarifying the reason for all the information, as well as clarifying how to score the QIs, is rewarding, especially when staff want to know.

The biggest challenges involve getting the information completed with documentation to support the information that goes on the IRF-PAI.

How did your clinical background prepare you for this role? Which skills transferred?

My previous experience in acute rehab and leadership positions helped prepare me for this role. However, any therapist who has scored GG codes would find it easy to prepare to score QIs, as they are the same. That said, the guidelines seem to be stricter and more well-defined in inpatient rehab.

Medical-record reviewing and being able to “picture” a patient based on the medical record and others’ documentation also prepared me for this role. Being collaborative, detail-oriented, and able to teach others transfers well, too.

Roughly speaking, how are the hours and pay compared to patient care?

I took a minor pay cut, but the hours are so much better. I work 40 hours a week (7:30am to 4pm or 8am to 4:30pm), only rarely working a little over that to get things done.

My last patient care job was home health, where I got paid for 72 hours every two weeks, but worked close to 100 hours.

I do currently have to work every other holiday, though. The other outcomes manager and I cannot ever be off on the same day due to time-sensitive information needing to be completed. We do not work weekends.

What type of person do you think would do well in your outcomes manager role?

I think a detail-oriented therapist who is knowledgeable and confident enough to follow the rules and regulations, as well as ask for supporting documentation to justify QI scores, would be best. Someone who does not mind routine tasks, reading patient medical records, and needing to ask others about information that is not complete or not well-supported.

It is best if someone can switch tasks regularly or get interrupted and then easily get back to what they were working on. I have very little to no direct patient contact—although I think others in similar positions in other facilities may take on roles that overlap with case management.

Do you work remotely or onsite?

I work onsite most of the time. However, with permission, I can work remotely occasionally, due to holidays, bad weather, or to be home for scheduled repairs.

Does your organization hire PT, OT, or SLP professionals into non-clinical roles? If so, what type of roles?

There are other therapists in outcomes manager positions. I think in the immediate area, most of the other outcomes managers are therapists; the other outcomes manager at my facility is an RN. 

The other typical non-clinical roles held by therapists in my organization are liaisons, therapy supervisors, and therapy directors. Our DQM (Director of Quality Management) is a PT.

Did you read any books, take any courses, or do anything special overall to get you where you are today?

I worked through most of Non-Clinical 101. I also have an MBA, but that is not necessary for this position. After starting as an outcomes manager, I took a PPS bootcamp, PPS certification course, and a test to become IRF PPS certified.

What is a typical career path for someone in your outcomes manager role?

I am not sure, but likely DQM (Director of Quality Management).

What is next for you? What are your high-level career aspirations?

I am learning the technical tools of data analytics. In March 2024, I started as a fellow for Bluebonnet Data, a non-profit organization empowering data and tech volunteers for political campaigns and organizations. I have a project portfolio hosted on Maven Analytics.

I like to challenge myself, and I really enjoy problem-solving. Data analytics, and data visualization in particular, are very creative.

What would you recommend to someone who is considering going into an outcomes manager role like yours? Do you have any special words of wisdom for the readers?

Make sure that you explore the culture as much as possible and find out which tasks you will be responsible for.

Go into it knowing that you will have to ask others for information and be strong enough to challenge others about their scoring and supporting documentation. You need to have tough skin in this role.

What would you like to change most in your profession, and why? How would you propose doing so?

As an OT, I would like to change how much we must defend our value and expertise.

It seems that OT has become less valuable over the last couple of decades. Part of that is due to changes in reimbursement. Part of it is that patients don’t always see the value of being able to improve independence with self-care.

I also wish organizations would focus less on productivity. I understand why they have to, but between the documentation requirements and the productivity requirements, it is causing therapists of all disciplines to want to leave in droves.

As for how to change it, I’m not sure, but some of it must be at the reimbursement level. I know that some places have OTs in primary care medical practices. I think that is a great model. There are so many things that can be addressed by OT in primary care. How that service is reimbursed, I don’t know.

What career advice would you give yourself that you wish you had during school?

If you think you might want to change careers, do it earlier rather than later in your career.

Also, I wish I had pursued something outside of healthcare after finishing my MBA, instead of waiting for the right therapy leadership position.

What would you teach to today’s graduate students in your profession, if you had the opportunity?

I would teach them to explore all areas of OT, know that they are going to be asked to do more with less (more documentation with less time), but continue to give their patients and clients the best care they can.

Do you have any special advice for others who want to follow in your footsteps as an outcomes manager?

Know that you will likely get push back, but be strong, stick up for the regulations, and be confident in your knowledge of QI scoring and IRF-PAI compliance.