More about…
Medicare, Medicare, Medicare.
In my last article, I wrote about the TWO THINGS that Medicare wants from us. The first thing is PAIN.
So now, let’s discuss the SECOND thing Medicare wants from us.
Function
Medicare requires that we perform a Functional Outcome Assessment for our patients. They define a Functional Outcome Assessment as “patient completed questionnaires designed to measure a patient’s limitations in performing the usual human tasks of living and to directly quantify functional and behavioral symptoms.”
But…
They also state that we must use a “standardized tool” and document a care plan “based on the identified functional outcome deficiencies.”
And…
They continue…“Documentation of a current functional outcome assessment must include identification of the standardized tool used.”
So what is a “standardized tool?” According to Medicare, it’s “a tool that has been normalized and validated.” That means you can’t just make one up.
But there’s more…
Medicare also states that “A functional outcome assessment is multi-dimensional and quantifies pain and neuromusculoskeletal capacity; therefore the use of a standardized tool assessing pain alone, such as the visual analog scale (VAS), does not meet the criteria of a functional outcome assessment standardized tool.”
So how often do we need to have our patients do these?
Medicare states, “The intent of this measure is for a functional outcome assessment tool to be utilized at a minimum of every 30 days.”
But there’s more…
Here’s Medicare’s rationale: “Standardized outcome assessments, questionnaires or tools are a vital part of evidence-based practice. Despite the recognition of the importance of outcomes assessments, questionnaires and tools, recent evidence suggests their use in clinical practice is limited. Selecting the most appropriate outcomes assessment, questionnaire or tool enhances clinical practice by (1) identifying and quantifying body function and structure limitations; (2) formulating the evaluation, diagnosis, and prognosis; (3) informing the plan of care; and (4) helping to evaluate the success of physical therapy interventions (Potter et al., 2011).”
Medicare also tells us that “clinicians should use validated self-report questionnaires/tools that are useful for identifying a patient’s baseline status relative to pain, function, and disability and for monitoring a change in a patient’s status throughout the course of treatment.”
Remember what I told you in my last article, though.
Medicare drives this whole train.
Everyone else follows Medicare. They created the documentation guidelines. They guide the CPT and ICD10 codes. So, instead of fighting them (and losing), we need to understand their perspective and follow their rules.
So, let’s break this down. For ALL of our patients, regardless if they’re a Medicare patient, cash-paying patient, personal injury patient or anyone else – it’s time we standardize this ONE thing – our documentation.
- Document the pain intensity and pain frequency for each complaint on every visit.
- Have the patients complete a functional outcome assessment utilizing a standardized tool. Document the name of each functional outcome questionnaire and its score.
- Formulate a treatment plan based on the functional outcome assessment score.
And don’t panic. This can be done in very little time. The results are worth it.
Be BulletProof.
