Rehab Goals, Outcomes and Cost
Establishing and working to achieve functional goals to address patient problems is the cornerstone of clinical practice for all therapists. Regardless of professional discipline or therapeutic focus, the requirement to execute a problem-oriented plan of care and monitor its effectiveness is basic to all rehabilitation practice.
The scrutiny of health care costs continue and a greater attention is now given to this standard of practice with the reporting of G-codes to describe the purpose of outpatient therapy as a requirement for payment in the Medicare program. Reporting requires a therapist to code the reason for therapy according to the patientu2019s functional problems addressed. This requirement has existed for commercial insurance carriers but now attempts to classify therapeutic goals by grouping functional problems into 14 functional areas of care:
Mobility: Walking and Moving Around
Changing & Maintaining Body Position
Carrying, Moving & Handling Objects
<span ‘Times New Roman’;”> Self-Care
<span’Times New Roman’;”> Other- Primary
<span’Times New Roman’;”> Other- Secondary
Spoken Language Comprehension
Spoken Language Expression
This is an attempt to understand what therapists do and figure out how much payment (cost) is associated with doing it. Asking for and measuring these goals will hopefully demonstrate the value therapy provides.
For all practicing clinicians participating in this attempt to quantify the value of therapy becomes a matter of utmost professional priority. The differences in how we practice and the language used to describe what we do must now find a common path or accept the standard provided by others. G-code reporting is one such attempt to classify potential functional problems seen in therapy into 14 categories.
A major shortcoming of this system is its limited classification of function; as if assuming that four areas of activity function are the only therapeutic value provided by therapists. The problem is an over simplification of the classification method to describe patient disability and related severity as seen by outpatient rehab services. Attempting to describe the purposes of outpatient therapy with these limited and general categories significantly constrains the complexity or diversity of patient problems addressed by therapists.
Problems and goals of therapy that address sensory functions and pain or respiratory functions are found nowhere unless related to performance of some activity; and yet the therapeutic purpose may be exclusively focused on these problems. Similarly, patient participation in social, community or family affairs are important rehabilitation goals requiring consideration and measurement but overlooked by G-coding.
The World Health Organization first created the international standards to describe and measure health and disability in 1980. Continuously updated, they provide a classification system upon which to build. The International Classification of Functioning, Disability and Health (ICF) is a conceptual basis for the definition, measurement and policy formulations for health and disability. The ICF is not a measurement system. Its standard language and taxonomy may be used to also classify a patientu2019s functional problems being addressed in rehabilitation care.
The matrix is derived from the ICF CHECKLIST for clinicians; it provides a more descriptive accounting of the scope of outpatient rehabilitation practice. This method of classification, while endorsed by the APTA, AOTA and ASHA, has not been widely used in ambulatory practices in the US.