"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, January 22, 2013

This is Only a Test...

Functional Reporting for Medicare in 2013 is only a test.

If Functional Reporting were true outcomes reporting physical therapists would need to use risk-adjusted outcomes measures, not paper questionnaires.

Instead of true outcomes reporting, physical therapists are only being assessed on our ability to report patient functional status via the claims system.

The Centers for Medicare and Medicaid (CMS) states in Transmittal 165 that this new system is designed to assess the ability of physical therapists to report patient functional status via claims forms, like the CMS 1500.

A trusted source at the APTA states that Medicare just wants physical therapists to show that we are using functional status measures and that we can predict change.

However, the change scores are not valid indicators of change.  And, the functional status scores can't be used as valid indicators of patient function. They can't even be used to compare my outcomes to your outcomes.

According to Jewell (p.154), "These (ordinal scores) are not measured with numbers, but are indicated with modifying words.  The absence of a known distance between each level of these scales means that mathematical functions cannot be performed directly with the measure."

Ordinal data, such as reported on the OPTIMAL scale, Oswestry, LEFS, SPADI, ABC, DHI, Berg etc. can't be used to do addition and subtraction, multiplication or division.

However, the new Medicare Severity Scale require physical therapists to convert the raw scale scores to percentage categories corresponding to modifiers that can be appended to the CMS 1500 paper or electronic claim form.
Medicare Severity Scale for G-code Modifiers
When this important detail was pointed out to me, I was initially surprised and disappointed.  I originally saw Functional Reporting as a stepping stone to true outcomes reporting.

Not the case, says my trusted source.  "Don't get caught up in the math," he said, "The numbers aren't important", he implied.

"Functional Reporting is here to stay but you're not measuring true outcomes and you shouldn't expect this data to be used to improve the reimbursement situation for physical therapists."

Like I said, this is only a test.

Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.