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|
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.