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Written by: Darlene D'Altorio-Jones (1959-2015) on Sunday, July 29, 2012 Posted in: Outpatient Rehab

Outcomes have been an established requirement in the outpatient evaluation and plan of care since 2008.  The Medicare Benefit Policy Manual; Chapter 15,  220.3.C. (updated 08/2011), outlines required outcomes for therapy documentation:

“Results of one of the following four measurement instruments are recommended, but not required:

– National Outcomes Measurement System (NOMS) by the American Speech-Language Hearing Association

– Patient Inquiry by Focus On Therapeutic Outcomes, Inc. (FOTO)

– Activity Measure – Post Acute Care (AM-PAC)

– OPTIMAL by Cedaron through the American Physical Therapy Association

If results of one of the four instruments above is not recorded, the record shall instead contain the following information indicated by asterisks (*), and should contain, but is not required to contain, all of the following, as applicable. Since published research supports its impact on the need for treatment, information in the following indented bullets may also be included with the results of the above four instruments in the evaluation report at the clinician’s discretion. This information may be incorporated into a test instrument or separately reported within the required documentation. If it changes, update this information in the re-evaluation, and/or Treatment Notes, and/or Progress Reports, and/or in a separate record. When it is provided, contractors shall take this documented information into account to determine whether services are reasonable and necessary.”

*Documentation required to indicate objective, measurable beneficiary physical function including, e.g.,:

– Functional assessment individual item and summary scores (and comparisons to prior assessment scores) from commercially available therapy outcomes instruments other than those listed above; or
– Functional assessment scores (and comparisons to prior assessment scores) from tests and measurements validated in the professional literature that are appropriate for the condition/function being measured; or
– Other measurable progress towards identified goals for functioning in the home environment at the conclusion of this therapy episode of care.”

For at least the last three years, Medicare has guided every plan to contain measurement criteria relevant to the functional loss. How often has this measurement been completed? Does your facility monitor those outcomes? Do you have data on the success of meeting the required objectives?

As previously covered in my colleague, Bob Habasevich’s, post on July 20, “ If all goes as proposed, therapists in outpatient settings will begin adding new codes to a Medicare patient’s bill or payment claim form on Jan. 1, 2013.  These new codes will be related to and describe the patient’s functional impairment for which treatment is requested; the status of that impairment at beginning, during and the end of care, and the goal to be achieved in treating the impairment.” “Specific codes to be known as G Codes will be assigned for each of these steps in the process.”If you have not taken the inclusion of functional outcomes into consideration, it will be increasingly more important as post acute care effectiveness and costs are being weighed. When completing the discharge summary, is the success of the measured outcome made prominent?  Has the treatment rendered provided the desired results?

Take a look at documentation provided in your clinic. If outcomes have lagged behind, or have been missing, now is the time to correct and emphasize their importance. The future of pay for performance and effective and efficient care practices will become the center of attention. Be prepared; provide staff the expectations for which measurements are most effective for the various functional impairments.Gather your results and share effectiveness. Better yet, determine the baseline that all should strive to achieve. Working toward improved outcomes is a winning goal for all stakeholders.

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